Ah, change. Isn’t it lovely? With the passage of the Patient Protection and Affordable Care Act (PPACA) last year, much change has been afoot and most of it has been rapid and frantic change. Many stakeholders, from physicians to health plans and from patients to employers, are probably not entirely comfortable with the ground beneath them moving and so quickly (though I would argue that here in California, we’re accustomed to the ground shaking). I would also argue one of the main reasons why folks are so darned uncomfortable is that the vector of our health care delivery system has begun to shift away from fragmented, volume-based to integrated, value-based care. My question for you, dear colleague, is: “Will you choose to sit on the sidelines or will you compete in the game?” This, of course, is a variation on the oft-repeated trope in organized medicine circles: “Either you’re at the table or you’re on the menu.”
As Dr. Roland Goertz, our AAFP President, stated at this past weekend’s CAFP Congress of Delegates (CoD): “Our time is now.” Let’s analyze what that means and its impact on our specialty:
We are all part of this sea of change whether we’re a country doc, a city doc, a public health official, an academic, part of a multi-specialty group, or in solo practice. This change is about showing the value that family medicine (and other primary care specialties) brings to the US health care system and doing so in a way that is purposeful, loud, and united. We can no longer be the silent sufferers that we have allowed ourselves to become (in the name of harmony). It’s ok for us to challenge and confront how our country delivers health care because that’s what the health care system needs, that’s what our economy needs, and most importantly, that’s what our patients need. We must revolt against the status quo and we must take ownership of the revolt.
Quietly, AAFP and other family medicine leaders (via collaboration with other like-minded groups such as the PCPCC) have worked to build the political capital necessary to put us in a position to live at the table, not die on the menu. Remember the “Future of Family Medicine” project? That was nearly 10 years ago. The landscape has changed quite a bit and the simple political fact that family medicine is helping to drive policy changes is simply remarkable. Time has been invested to put us in the position to make significant changes in health care delivery. The idea of accountable care organizations (ACOs), for example, has not been fully differentiated just yet but theoretically, the health care provided via ACOs using patient-centered medical home (PCMH) models should value primary care services better than the current fee-for-service model does now. The amount of time that each of us will need to devote to remaining at the table in our local markets will be critically important.
Remember managed care in the 1990s? Remember how few physicians were truly engaged in the process? We do not have time to wait and see whether PPACA will live or die in our judicial system. We do not have time to sit back and hope that this will just pass us by like managed care did in the 1990s. Our time is now. Our leadership as family physicians is more crucial than ever before. We must not sit idly by and allow others to shape the health care system. We must revolt against the status quo.
Last year, an inspired group of residents started a Family Medicine T-shirt Revolution. These t-shirts said things like: “Use all parts of your brain; be a family physician” and “Americans are dying to have a family doc.” Their focus was on raising awareness, particularly among medical students, about the importance of family medicine and cautioning against being intimidated by academics, who have steered many bright students away from primary care.
Well, let’s take this one step further, shall we?
Many of you are on social media like Facebook or Twitter. Let’s start a Family Medicine Revolution campaign called #FMRevolution. My vision is two-fold: (1) that family physicians and other primary care providers embrace this idea that we are better than what the status quo values us at and that we need to ‘revolt’ against the currently fragmented health care delivery machine that exists right now (we’ve been great playing in the sandbox historically, but we have a political window right now to shift the health care system vector permanently away from volume-based FFS and toward value-based care); (2) that the general public sees this anti-establishment health care reform movement and embraces it (though the overarching goals of #FMRevolution and #hcr are the same, ultimately, the American public trusts their doctors more than their government).
Whenever you post an article or status update that is family medicine-oriented, simply add #FMRevolution. Let’s bring medicine back to our patients and their communities. Vive la résistance!
The CAFP Foundation has made the Family Medicine Revolution one of its top priorities, and is putting staff and resources in place to help. A FMRevolution website, with interactivity, will be launched in May. Watch for more, and be ready to take part in the Revolution!
Jay W. Lee, MD, MPH