Referring to Christopher Gergen and Stephen Martin’s May 10 Doing Better at Doing Good business article “Lack of doctors a looming crisis in N.C.”: It is encouraging to note that the national Society of Teachers of Family Medicine has elected Mary Hall as president. Hall has noble and ambitious goals of both creating a strong supply chain of primary care physicians and developing a new team process for transforming the way they work, both enormous challenges especially because medical schools remain resistant to changing from the 1910 tenants of Abraham Flexner.
Flexner’s thesis was launched under the aegis of the Carnegie Foundation, demanding a standardized science-based model for medical teaching in the classroom and at the bedside, which continues vigorously today, fueled largely by a third-party relative value reimbursement scheme developed by Blue Cross Blue Shield in the 1950s to reimburse hospitals and surgeons for their care, incidentally totally ignoring primary care.
Indeed, nationally the medical schools are so dependent on third-party reimbursement that they are failing to lead and are internally resistant to change, motivated by an instinct to preserve the status quo, especially as it comes to the team and medical home approach that Hall and many of us see as necessary.
The decline in all physician reimbursements by third parties has accelerated under the influence of managed care in the past 30 years and has complicated the evolution of the team approach.
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It has forced primary care physicians to attempt to financially compensate with higher patient loads. Add to this electronic medical records, increasing demands for compliance in every practice setting, the inevitability of quality measurement and value-based purchasing, and the perception of the loss of physician control as the flip side of the evolution of a team approach, and we begin to see the enormity of Hall’s challenge. We wish her well!
C. Franklin Church
Past president, N.C. Academy of Family Physicians
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