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Corresponding Author(s)
Corresponding Author: Kevin de Regnier, DO, FACOFP dist. 2015 ACOFP President Email: president@acofp.org
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FROM THE PRESIDENT’S DESK
The "True" Value of Family Medicine
Kevin de Regnier, DO, FACOFP dist. 2015 ACOFP President
A couple of days ago, I spent a ridiculous amount of time arguing with an insurance company trying to get them to pay for the medication I felt my patient needed. A few days earlier, I had to request a conversation with the radiologist because the insurance company algorithm said my patient didn't need an MRI.
I ultimately got both requests approved but my blood was boiling and I was questioning why I became a family physician. Having to continually justify my every action to some insurance clerk is not what I signed up for. Who would want to do this for a living?
I do! One of the great things about being President is that I have the opportunity to talk to students and show them why they too should become osteopathic family physicians. I know that may sound a little ironic given my opening rant, but hear me out.
I believe the future of osteopathic family medicine has never been brighter. For the ninth year in a row, family medicine is the number one recruited specialty.1 Between 2013 and 2014, average family physician compensation increased 10%, the fourth highest increase of 25 specialties surveyed.2
In recent years, policy makers and payers have been asking why the United States spends more money on health care than any other industrialized nation3 and yet ranks last in the quality of care delivered.4 According to several researchers, the United States’ ranking is dragged down substantially by deficiencies in access to primary care and inequities and inefficiencies in our health care system.4, 5
According to Barbara Starfield, MD, MPH from the Commonwealth Fund, the US physician specialty mix is dramatically different than other industrialized nations who have higher quality and lower costs. According to the Commonwealth Fund Primary Care Roundtable 1, Adults (age 25 and older) with a primary care physician rather than a specialist as their personal physician had 33% lower cost of care and were 19% less likely to die.6
Primary care physician supply is consistently associated with improved health outcomes (all-cause, cancer, heart disease, stroke, infant mortality, low birth weight, life expectancy, self-rated health). A 12% increase in such physicians (1 per 10,000 population) improves outcomes an average of 4% (range 1.3% to 10.8%; depending on the particular outcome and geographic unit of analysis).6
In the United States, an increase of one primary care doctor is associated with 1.44 fewer deaths per 10,000 population. Above a certain level of specialist supply, the more specialists per population, the worse the outcomes. In 35 analyses dealing with differences between types of areas (7) and 5 rates of mortality (total, heart, cancer, stroke, infant), the greater the primary care physician supply, the lower the mortality for 28 analyses whereas the higher the specialist ratio, the higher the mortality in 25 analyses.6
It is clear from this data that the solution to America's healthcare crisis is to dramatically increase the number of family physicians and other primary care physicians caring for patients. The remaining question is how to accomplish that goal. We know that family medicine suffers from both an internal and an external identity crisis. Family physicians often rail against the system as I did in my opening paragraphs. Yet of 26 specialties surveyed, family physicians are the most satisfied with their career in medicine.2
The key to improving both the image and lot of family physicians is taking this message to those who make healthcare policy in the US. This includes members of Congress, insurance company executives, healthcare leaders, academics, and the public. This is one of the key goals of Family Medicine for America's Health.
FMAH is a joint project of the eight family medicine organizations in the US. Together as FMAH we are taking this message to those who need to hear it. We will no longer be content to wait for the world to "discover" the true value of family medicine. Ultimately, we are in charge of our own destiny, and to me, the future looks very bright.
REFERENCE
2015 Review Of Physician And Advanced Practitioner Recruiting Incentives, Merritt Hawkins, 2015, http://www.merritthawkins.com// uploadedFiles/MerrittHawkins/Pdf/2015_Merritt_Hawkins_NP_PA_ Physician_Recruiting_Survey_Preview.pdf, accessed 9/9/2015
Medscape Family Physician Compensation Report 2015, http:// www.medscape.com/features/slideshow/compensation/2015/ familymedicine#page=3, accessed 9/9/2015
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?order=wbapi_ data_value_2013+wbapi_data_value+wbapi_data_value- last&sort=asc, accessed 9/9/2015
http://www.commonwealthfund.org/publications/press- releases/2014/jun/us-health-system-ranks-last, accessed 9/9/2015
http://www.commonwealthfund.org/publications/fund- reports/2014/jun/mirror-mirror, accessed 9/9/2015
Barbara Starfield, MD, MPH, The Commonwealth Fund Primary Care Roundtable: Strengthening Adult Primary Care: Models and Policy Options, October 3, 2006
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