Family Medicine started as a "counter culture" specialty in the late 1960's with an opportunity to facilitate a course correction for the medical profession. Redirect medical care toward patients. Redirect academic medical centers toward patients. But no, we came up short. To quote from G. Gayle Stephens, MD in his presentation "Family Medicine as Counter Culture" in 1979, "We have expended our energy on professional legitimation and enfranchisement rather than reform."
As we recently got employed by corporate interests such as hospitals and gave up hospital care of patients, we left the culture we sought to reform. We responded to quota mandates, giving up the opportunity to effect the best outcomes for our patients in exchange for a comfortable lifestyle. We can crank out the patients if we listen less and get efficient, to better support health system needs. We can game the satisfaction surveys and get a high level of approval. The more superficial we become, the more our patients feel disconnected and the more emergency room visits they experience with higher and higher expense at less and less overall quality. Now we're aligned more with shareholder value for the system than with our patients.
We're broke financially if not comfortably established in a corporate system, sometimes groveling for dollars with procedural schemes to attempt to have a cash flow increase. We've lost our direction and forgotten our purpose. What happened? How do we get realigned with the people? Is it too late?
The Patient Centered Medical Home (PCMH) is supposed to be the model that buys our freedom and our realignment as family physicians. In many ways, though, it looks more like the "Payment" Centered Medical Home. It's supposed to save primary care and optimize care coordination with a team approach to primary care. But how is the patient engaged in the new model? Who is training patients and employers to connect to the model? Who is protecting the family physician from a massive work addition and burnout during and after the transformation of our practices into Medical Homes?
We attacked the windmills and had some victories, but now it looks like the last windmill defeated us. Family Medicine and our patients are losing fast. I've written before that five family physicians left practice in my county in the last 19 months, leaving around 10,000 patients without a physician. There are now two major hospital health systems in this area and both flagship hospitals closed their family medicine training centers in the last two years and built heart hospitals that opened in 2010. Who will protect the employers from the expense that is headed their way? Do they even see it coming?
Who will answer?, I keep thinking as I hear the old Ed Ames song by the same title playing in my head. There is no way this community can afford the medical care system that is being built for them. Three heart hospitals and a diminishing primary base. It looks like our specialty, family Medicine, has failed to lead in a way that would best serve the medical needs of the people. I am very worried. Who will answer?