Pub. 3 2019 Issue 2

Kyle Bradford Jones, M.D., FAAFP PRESIDENT’S MESSAGE I often wonder what makes a good physician. • Is it intelligence first and fore- most? • Is bedside manner most impor- tant? • Do good physicians have great diagnostic skills through pattern recognition? • What if we are meeting all of our “quality” metrics? • Or do good physicians apply all these elements to our patients when and how they need it? Probably the question that should be answered first is what we, as a society, want fromour physicians. I ask myself these questions partially in a philosophi- cal manner, but also in a practical manner. How do I know if I amdoing all that I can for my patients? While I don’t have a good answer much of the time, I can say with confidence that family physicians as a whole encompass all the characteristics of good physicians. As we all know, the payers, health sys- tems, and regulators have largely decided what a good physician is. Their decisions, basedmainly on quality metrics and patient satisfaction, often have little cor- relation to patient health. Business behavior (and yes, unfortu- nately, health care is a business) can be shaped either by proper incentives or regulation. The structure and nature of health care have perverse incentives that are not present in other industries, and so regulatory bodies have stepped in to achieve the desired endpoints in medicine. But regulation has gone too far. With all of the pressures that we face fromoutside entities—an endless list of interference in decisions about matters such as prior authorizations, EMRs, and the encroachment of limited scope of practice—we are set up to fail. Toomany physicians are leaving the profession at increased rates after being forced out of the noblest of professions against their will. Evenmany of us who remain in practice are prevented from achieving our ideal of what it means to be a good physician because of the internal frustra- tion andmuted passion resulting from these external forces. The term “burnout” has become so ubiquitous as to have lost much of its meaning, but its impact is real. Medicine in general, and primary care specifically, initially appears as if it is dying on the table. The AAFP spends immense resources of time andmoney working with the Centers for Medicare andMedicaid Services, leg- islators, private insurers, and other stake- holders to alleviate these burdens. Given the health care behemoth that we have in this country, however, their successes have beenminimal and incremental. Health care has been appropriately de- scribed as the most complicated creation of the human race. When you consider all the different entities involved, it’s not a surprise that we haven’t dramatically improved things. These entities present many issues, including the following: • Efforts tomake money and promote their interests • A lack of coordination • Overregulation in some areas with little-to-no regulation in others We wouldmake more headway in solv- ing the problems we face if we were to educate the general public about the value that we provide. Many people don’t understand what sets us apart as primary care physicians, and they also fail to see the extent to which we benefit patients and the entire health care system. This lack of understanding is widespread even though we remain a highly respected field among the general public, and it causes many of the difficulties we face that ulti- mately impact our ability to provide qual- ity patient care. Society needs to know howmuch benefit we provide so that we can get the support needed to care for patients. When you look at all of the medi- cal specialties, family physicians provide the best quality of care, with the best health outcomes, for the least amount spent. Everyone needs to know this. I encourage you to educate the public on both what we provide and some of the barriers we have to achieve that individual and societal good fully. We need public support to put more pressure on payers, regulators, and large health care systems tomeet the needs of ourselves and our patients. Let our patients and the general public know how ever-increasing regula- tion prevents us fromproviding our full value. Write an op-ed for your local news- paper. Contact your legislator. Tell those with whom you interact socially. Write to insurance companies with productive recommendations to improve our ability to care for patients. Ask a journalist to do a story and have them follow you around your clinic for a day. Spread our story over social media. We won’t be able to address our concerns without better understand- ing and pressure from all angles. At the same time, UAFP needs to knowwhat your biggest issues are so that we can help. We are aware and working onmany of these problems already, but we need your input and assistance, too. We also need your help serving on our committees. We are currently recruiting members to serve on our Communica- tions Committee andMember Engage- ment Committee. Your input is vital. We have to keep doing everything that we can to improve our system for our patients’ sake. Please contact UAFP if you are interested in volunteering your time and expertise. We can’t become good physicians when we are so hamstrung by external forces, which can also harmour patients. But nothing changes without our voice. We need your help. By advocating clearly for the changes that need to happen, we have the potential to offer muchmore value to the health of everyone than we can currently offer because of the artificial roadblocks in our way. Kyle Bradford Jones, M.D., FAAFP Director of primary care, Neurobehavior HOME Program Associate professor, Dept. of Family and Preventive Medicine University of Utah 5 |