A Family Physician’s Manifesto

As a third-year medical student in 1977, I joined the American Academy of Family Physicians (AAFP).  In those culturally tumultuous years, it was a way to declare my belief that America needed physicians who cared for the whole person, family and community. It was also a declaration that, in choosing the primary care path in a field ripe with tempting medical specialties, money was not my primary goal.

For much of my 33-year membership, I have considered the AAFP to be “my” organization. However, there is a time when one must step back and declare independence from organizations that have lost touch with their members.  The AAFP does much that supports my day-to-day life as a busy family doctor, but for 33 years, its leadership has failed to fix the central problem for primary care in America: poor reimbursement.

I deal every day with complicated health problems of complex patients who are insured by companies singularly focused on limiting even the smallest cost.  In return for managing these patients, which often involves critical and life-or-death decisions, I am paid by Medicare 60% less per hour than is a dermatologist, who, for the most part, treats trivial disease that involves no nighttime emergencies and little intellectual challenge.

The AAFP has implicitly supported this payment fiasco through its membership in the RUC, a committee of organizations focused primarily on defending surgical and specialty fees while ignoring the growing challenges and costs of the practice of primary care.  Because the RUC advises Medicare on physician reimbursement, the AAFP’s involvement is tacit agreement with a reimbursement plan that undermines the health of primary care and, hence, the health of the country.

In light of the organization’s failure to effectively advocate through the RUC on behalf of its members for crucial change in physician reimbursement, I strongly urge the AAFP to immediately withdraw from the RUC and work to establish an alternative means of impacting Medicare’s physician payment decisions for the good of primary care and American health care.

Fellow primary care physicians who wish to communicate the same sentiment to their societies may find a prepared letter here.

Paul Fischer, MD, is a primary care physician in Augusta, GA.

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