Erik Goldman12.01.07
If you want to find out what's going on in the trenches of healthcare, the American Academy of Family Physicians (AAFP) annual scientific as-sembly is an excellent place to start. The organization represents the nation's 95,000-plus board certified family physicians, those most general of general practitioners and most primary of primary care doctors. The relative health of the family medicine sector reveals a lot about the state of healthcare for millions of Americans.
To say the situation is dire is putting it mildly. This year's conference, held in Chicago, IL, in October, was marked by one clear and overriding theme: family medicine is struggling for its very survival.
For years, the healthcare reimbursement system has preferentially rewarded discrete and quantifiable therapeutic procedures, high-tech diagnostic imaging, and acute care interventions for very ill people. Since family physicians don't do a whole lot of those, they're dependent on the much less lucrative "evaluation and management" codes. Federal payors and insurance companies have been chipping away at those reimbursement rates for much of the last 20 years. Primary care has al-ways been the low end of the medical money hierarchy, and it just keeps getting lower.
At the same time, managed care plans have placed FPs as the "gatekeepers" of the healthcare system, making them a necessary first stop for patients seeking care. This means their patient volumes have increased steadily, even as their reimbursement shrinks. They're working more, getting paid less. To add insult to injury, they're facing an ever-rising burden of bureaucratic hassles-the average primary care group practice now has to pay two or more administrative staffers for every doctor on the team.
The way things are going, the latter seems much more likely. The number of recent med school grads choosing careers in family practice is at an all-time low, and many already in the field are looking for ways out. During the course of the conference, I spoke with a disturbing number of doctors who are seriously rethinking their careers: they're considering re-training for some sort of procedure-based specialty care, or simply thinking about ditching medicine altogether. The realities of medical practice seem to be almost diametrically opposed to the aspirations and vi-sions that inspired them to become doctors in the first place.
And it's not just the 50+ "thinking about very early retirement" crowd. It's young doctors in their 30s and 40s, just a few years out of training and at a point where they should be energetically engaged in building their practices. Instead, they're actively looking for a way out of the morass their chosen profession has become. They're burnt out, bruised up and beaten down, and they don't want to spend the rest of their productive lives slaving away in a system that fails to recognize the value of what they offer.
Some of the young docs I spoke with are actively seeking something else; others have resigned themselves to the status quo at least "until the kids are in college" or "the med school debt is paid." The point is, no one in family medicine is happy. And that should be deeply troubling to all of us.
The AAFP is very well aware of the discontent, and struggling to re-spond. The organization recently revamped its logo and is embarking on a multimillion-dollar PR campaign centered on the slogan "Strong Medicine for America," in an attempt to gain public support for good ol' basic family healthcare. AAFP is also marshalling a war chest to make sure family medicine is well-represented in Washington, D.C., as healthcare once again becomes a pressing domestic issue.
The group is also offering members all sorts of tutorials and guidance on practice development, practice management, implementation of electronic medical records and other business oriented topics.
Where there is desperation, there is often opportunity and open-mindedness. Although the overall picture was sad and troubling, there was one very clear and bright ray of hope: a newfound openness to nutrition and natural healthcare.
I was pleased to see a very strong showing of nutrition-based, natural medicine companies in the exhibit hall and some very substantial educational sessions on nutritional medicine, functional medicine, stress reduction and other "holistic" approaches in the AAFP conference agenda.
This is a major shift for AAFP. The last time I attended this show, about 10 years ago, the organization had a pretty restrictive attitude toward representation of "alternative" medicine in its conference proceedings, and there were very few, if any, nutritional product companies on the show floor, with the exception of a few Big Food companies pushing high-fiber cereals or fortified orange juices and whatnot. By and large, AAFP's ex-hibitors represented Big Pharma, the medical device industry, and little else.
Big Pharma is still the mainstay in this sector, but this year, in addition to yogurt companies (with our beloved Stonyfield Farms right up there with Dannon), General Mills (Cheerios are indeed heart-healthy!), the Almond Board of California, and other Big Food players, I saw strong representation from a number of the leading practitioner-oriented nutraceutical companies, including Nordic Naturals, Metagenics, Douglas Laboratories, PRN Nutraceuticals and Everidis.
The Institute for Functional Medicine, biofeedback pioneers HeartMath, and several companies marketing guided nutrition and weight management programs were also exhibiting. Friends and colleagues from all of these companies were pretty uniform in reporting that physician attendees this year were extremely open to ex-ploring nutrition and natural therapeutics as viable approaches to disease prevention and management.
That interest was evident in the educational sessions as well. David Jones, MD, the Institute for Functional Medicine's president and chief medical officer, presented the assembly with a well-attended Introduction to Functional Medicine lecture. Dr. Robert Bonakdar, from Scripps Center for Integrative Medicine, who spoke on natural approaches to pain management and practical nutrition-based medicine, and Dr. Steven Masley, a Florida practitioner who gave a pair of lectures on clinical nutrition, both won rave reviews from AAFP attendees.
So something is clearly shifting in the attitudes of mainstream family physicians. Whether it is simply a reflection of their economic desperation, a desire to please their alternative-minded patients, or a genuine interest in what natural medicine has to offer, I believe it is a very positive and encouraging signal for the nutra-ceuticals industry. Primary care doctors are actively seeking real solutions beyond the drug-based, insurance dominated status quo, and they will respond positively to products and services that have true value and science to support them.
The show floor and conference proceedings also reflected the emergence of new economic models that better support primary care practice. Con-cierge practices-models in which physicians charge patients an annual membership fee in exchange for unrestricted access and comprehensive care-are clearly gaining ground as an alternative to traditional insurance structures. Several concierge network companies were exhibiting at the meeting, as were dozens of companies proffering electronic tools for building, marketing and managing a primary care practice.
Practitioners, patients and big employers all agree that we need more humanistic, equitable, affordable and prevention-oriented medicine, and that the practice of this medicine must be economically viable. As mainstream healthcare continues its downward economic spiral, we're likely to witness a proliferation of innovative new practice models. The key is to connect all those discouraged practitioners with a better way of doing things-before they bail out of medicine completely.
To this end, Holistic Primary Care-News for Health & Healing is planning its first-ever conference, to be titled "Heal Thy Practice: Transforming Primary Care." The meeting, to be held in Arizona from Oct. 31-Nov. 2, 2008, will explore the economically viable models for establishing successful, prevention-centered, health-oriented primary care practices. Feel free to email us at conference@
holisticprimarycare.net for more details on the meeting.NW
To say the situation is dire is putting it mildly. This year's conference, held in Chicago, IL, in October, was marked by one clear and overriding theme: family medicine is struggling for its very survival.
For years, the healthcare reimbursement system has preferentially rewarded discrete and quantifiable therapeutic procedures, high-tech diagnostic imaging, and acute care interventions for very ill people. Since family physicians don't do a whole lot of those, they're dependent on the much less lucrative "evaluation and management" codes. Federal payors and insurance companies have been chipping away at those reimbursement rates for much of the last 20 years. Primary care has al-ways been the low end of the medical money hierarchy, and it just keeps getting lower.
At the same time, managed care plans have placed FPs as the "gatekeepers" of the healthcare system, making them a necessary first stop for patients seeking care. This means their patient volumes have increased steadily, even as their reimbursement shrinks. They're working more, getting paid less. To add insult to injury, they're facing an ever-rising burden of bureaucratic hassles-the average primary care group practice now has to pay two or more administrative staffers for every doctor on the team.
It's a Recipe for Revolution…or Implosion
The way things are going, the latter seems much more likely. The number of recent med school grads choosing careers in family practice is at an all-time low, and many already in the field are looking for ways out. During the course of the conference, I spoke with a disturbing number of doctors who are seriously rethinking their careers: they're considering re-training for some sort of procedure-based specialty care, or simply thinking about ditching medicine altogether. The realities of medical practice seem to be almost diametrically opposed to the aspirations and vi-sions that inspired them to become doctors in the first place.
And it's not just the 50+ "thinking about very early retirement" crowd. It's young doctors in their 30s and 40s, just a few years out of training and at a point where they should be energetically engaged in building their practices. Instead, they're actively looking for a way out of the morass their chosen profession has become. They're burnt out, bruised up and beaten down, and they don't want to spend the rest of their productive lives slaving away in a system that fails to recognize the value of what they offer.
Some of the young docs I spoke with are actively seeking something else; others have resigned themselves to the status quo at least "until the kids are in college" or "the med school debt is paid." The point is, no one in family medicine is happy. And that should be deeply troubling to all of us.
The AAFP is very well aware of the discontent, and struggling to re-spond. The organization recently revamped its logo and is embarking on a multimillion-dollar PR campaign centered on the slogan "Strong Medicine for America," in an attempt to gain public support for good ol' basic family healthcare. AAFP is also marshalling a war chest to make sure family medicine is well-represented in Washington, D.C., as healthcare once again becomes a pressing domestic issue.
The group is also offering members all sorts of tutorials and guidance on practice development, practice management, implementation of electronic medical records and other business oriented topics.
Where there is desperation, there is often opportunity and open-mindedness. Although the overall picture was sad and troubling, there was one very clear and bright ray of hope: a newfound openness to nutrition and natural healthcare.
I was pleased to see a very strong showing of nutrition-based, natural medicine companies in the exhibit hall and some very substantial educational sessions on nutritional medicine, functional medicine, stress reduction and other "holistic" approaches in the AAFP conference agenda.
This is a major shift for AAFP. The last time I attended this show, about 10 years ago, the organization had a pretty restrictive attitude toward representation of "alternative" medicine in its conference proceedings, and there were very few, if any, nutritional product companies on the show floor, with the exception of a few Big Food companies pushing high-fiber cereals or fortified orange juices and whatnot. By and large, AAFP's ex-hibitors represented Big Pharma, the medical device industry, and little else.
Big Pharma is still the mainstay in this sector, but this year, in addition to yogurt companies (with our beloved Stonyfield Farms right up there with Dannon), General Mills (Cheerios are indeed heart-healthy!), the Almond Board of California, and other Big Food players, I saw strong representation from a number of the leading practitioner-oriented nutraceutical companies, including Nordic Naturals, Metagenics, Douglas Laboratories, PRN Nutraceuticals and Everidis.
The Institute for Functional Medicine, biofeedback pioneers HeartMath, and several companies marketing guided nutrition and weight management programs were also exhibiting. Friends and colleagues from all of these companies were pretty uniform in reporting that physician attendees this year were extremely open to ex-ploring nutrition and natural therapeutics as viable approaches to disease prevention and management.
That interest was evident in the educational sessions as well. David Jones, MD, the Institute for Functional Medicine's president and chief medical officer, presented the assembly with a well-attended Introduction to Functional Medicine lecture. Dr. Robert Bonakdar, from Scripps Center for Integrative Medicine, who spoke on natural approaches to pain management and practical nutrition-based medicine, and Dr. Steven Masley, a Florida practitioner who gave a pair of lectures on clinical nutrition, both won rave reviews from AAFP attendees.
So something is clearly shifting in the attitudes of mainstream family physicians. Whether it is simply a reflection of their economic desperation, a desire to please their alternative-minded patients, or a genuine interest in what natural medicine has to offer, I believe it is a very positive and encouraging signal for the nutra-ceuticals industry. Primary care doctors are actively seeking real solutions beyond the drug-based, insurance dominated status quo, and they will respond positively to products and services that have true value and science to support them.
The show floor and conference proceedings also reflected the emergence of new economic models that better support primary care practice. Con-cierge practices-models in which physicians charge patients an annual membership fee in exchange for unrestricted access and comprehensive care-are clearly gaining ground as an alternative to traditional insurance structures. Several concierge network companies were exhibiting at the meeting, as were dozens of companies proffering electronic tools for building, marketing and managing a primary care practice.
Practitioners, patients and big employers all agree that we need more humanistic, equitable, affordable and prevention-oriented medicine, and that the practice of this medicine must be economically viable. As mainstream healthcare continues its downward economic spiral, we're likely to witness a proliferation of innovative new practice models. The key is to connect all those discouraged practitioners with a better way of doing things-before they bail out of medicine completely.
To this end, Holistic Primary Care-News for Health & Healing is planning its first-ever conference, to be titled "Heal Thy Practice: Transforming Primary Care." The meeting, to be held in Arizona from Oct. 31-Nov. 2, 2008, will explore the economically viable models for establishing successful, prevention-centered, health-oriented primary care practices. Feel free to email us at conference@
holisticprimarycare.net for more details on the meeting.NW
