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Sorry going long, not sorry
1/?
Letterhead
From: All primary care docs (community, employed in large network, academic medical centers)
To: #healthcare system writ large, administrators/financial lever pullers
Sorry going long, not sorry
1/?
Letterhead
From: All primary care docs (community, employed in large network, academic medical centers)
To: #healthcare system writ large, administrators/financial lever pullers
2/
Primary care docs are in a precariously fatigued way
We deliver longitudinal relational care, which is foundational to the whole person rewarding work we need to be professionally happy, and to the revenue and reputational growth you need to maintain community market
Primary care docs are in a precariously fatigued way
We deliver longitudinal relational care, which is foundational to the whole person rewarding work we need to be professionally happy, and to the revenue and reputational growth you need to maintain community market
3/
Primary care docs fulfill an indispensable role not just in the local setting, but we provide what all the country and our society desperately needs - coordination and high value care in a system that overspends and doesn’t provide universal access nor competitive outcomes
Primary care docs fulfill an indispensable role not just in the local setting, but we provide what all the country and our society desperately needs - coordination and high value care in a system that overspends and doesn’t provide universal access nor competitive outcomes
4/
And data is clear patients have greater quality of care and longevity with a primary care doc
That said, we primary care docs feel taken advantage of at your hands. You think we’re too busy with incessant pace and volume to notice, … but here’s what we know :
And data is clear patients have greater quality of care and longevity with a primary care doc
That said, we primary care docs feel taken advantage of at your hands. You think we’re too busy with incessant pace and volume to notice, … but here’s what we know :
5/
We are not valued; we are paid less by payers for all levels of service
Every hour of patient facing time produces two hours of documentation and administrative work - that is done on our own time and invades our lives. You don’t acknowledge this
We have no hand in ..
We are not valued; we are paid less by payers for all levels of service
Every hour of patient facing time produces two hours of documentation and administrative work - that is done on our own time and invades our lives. You don’t acknowledge this
We have no hand in ..
6/
patient visit times (always less), flexibility to adjust for complexity(no), panel size (limitless), metrics that matter (chosen for us from CMS/ACO menus), EHRs (billing instruments w rapid workarounds for new metric choices, but not for doc saving interoperability), ..
patient visit times (always less), flexibility to adjust for complexity(no), panel size (limitless), metrics that matter (chosen for us from CMS/ACO menus), EHRs (billing instruments w rapid workarounds for new metric choices, but not for doc saving interoperability), ..
7/
productivity targets baked into contracts (commodity squeeze), presence or absence of scribes (almost never, told we don’t make enough to pay 4them), support staff ratios (many docs/MOA, little EHR task help, stretched RN/sec support)
You don’t acknowledge our skill/agency
productivity targets baked into contracts (commodity squeeze), presence or absence of scribes (almost never, told we don’t make enough to pay 4them), support staff ratios (many docs/MOA, little EHR task help, stretched RN/sec support)
You don’t acknowledge our skill/agency
8/
You make us feel like commoditized cogs, not valued autonomous adults ever included in a discussion re business model choices made 4us
Why treat us in such a financially unfriendly way?
Why RVU? Dehumanized visit times? Clawbacks on salary? Hi FTE contracts 4starters?
You make us feel like commoditized cogs, not valued autonomous adults ever included in a discussion re business model choices made 4us
Why treat us in such a financially unfriendly way?
Why RVU? Dehumanized visit times? Clawbacks on salary? Hi FTE contracts 4starters?
9/
We need to discuss how many pts we can cognitively/physically/safely see before there is perpetual exhaustion
If we say we are spread way too thin already, refrain from percentile talk, faulty data &insistence on national averages. Data hunts shouldn’t keep pleas at bay
We need to discuss how many pts we can cognitively/physically/safely see before there is perpetual exhaustion
If we say we are spread way too thin already, refrain from percentile talk, faulty data &insistence on national averages. Data hunts shouldn’t keep pleas at bay
10/
Trust us if we say our current panel size keeps us working in an uncompensated overwhelmed family denying way nights/weekends, delays call backs &discharge f/ups
The more pts we see past reasonable, the more dissatisfied pts are, &more they see others 4sick calls, preops
Trust us if we say our current panel size keeps us working in an uncompensated overwhelmed family denying way nights/weekends, delays call backs &discharge f/ups
The more pts we see past reasonable, the more dissatisfied pts are, &more they see others 4sick calls, preops
11/
We must advise current EHR upgrades, so that they become pt&doc serving platforms that don’t make repeat clicks always necessary, failing 2link dashboards w events w/o our extra work
Some of us teach medical students, residents, fellows; build curricula, do community work,
We must advise current EHR upgrades, so that they become pt&doc serving platforms that don’t make repeat clicks always necessary, failing 2link dashboards w events w/o our extra work
Some of us teach medical students, residents, fellows; build curricula, do community work,
12/
do non funded research &mentor extensively, do DEI or wellness committee work
All of this becomes uncompensated pajama time work, &while good for your portfolio, prestige &teaching income, it too often feels like a tax on our good will &care for learners/teams/community
do non funded research &mentor extensively, do DEI or wellness committee work
All of this becomes uncompensated pajama time work, &while good for your portfolio, prestige &teaching income, it too often feels like a tax on our good will &care for learners/teams/community
13/
And what of our burnout? Our occasional depression? What of our earlier retirements? What of the cost to you to replace a lost primary care doc in a timely way so as not to lose the pts in their panel?
Don’t YOU want a less compressed primary care doc w
time 2listen?
And what of our burnout? Our occasional depression? What of our earlier retirements? What of the cost to you to replace a lost primary care doc in a timely way so as not to lose the pts in their panel?
Don’t YOU want a less compressed primary care doc w
time 2listen?
14/
Don’t YOUR parents deserve the same? YOUR kids? We want to enter the exam room brimming with energy and love for our work
The facts:
Short term ledger thinking will never make primary care practices or divisions look great revenue wise
By definition, our success is
Don’t YOUR parents deserve the same? YOUR kids? We want to enter the exam room brimming with energy and love for our work
The facts:
Short term ledger thinking will never make primary care practices or divisions look great revenue wise
By definition, our success is
15/
realized incrementally over the long term
Primary care docs have unfair inappropriate financial expectations put upon their practices. It is the cause of hour to hour unhappiness
This is bleeding into the patient doc space, which is chronically under resourced
realized incrementally over the long term
Primary care docs have unfair inappropriate financial expectations put upon their practices. It is the cause of hour to hour unhappiness
This is bleeding into the patient doc space, which is chronically under resourced
16/
We are losing primary care docs especially on the heels of covid, an ongoing travesty through which our financial pressures, productivity targets and mission based work never abated
Trainees just aren’t sure they can proceed w a career in primary care as it is valued now
We are losing primary care docs especially on the heels of covid, an ongoing travesty through which our financial pressures, productivity targets and mission based work never abated
Trainees just aren’t sure they can proceed w a career in primary care as it is valued now
17/
This is a tremendous disservice to communities and society
Primary care calls for foundational investment that is not obsessed with the short term ledger. Embedded behavioral health, social work, pharmacy, proper MD/MOA ratio, standard RN/MD ratio, scribes should not be
This is a tremendous disservice to communities and society
Primary care calls for foundational investment that is not obsessed with the short term ledger. Embedded behavioral health, social work, pharmacy, proper MD/MOA ratio, standard RN/MD ratio, scribes should not be
18/
subject of never ending funding fights for us. It is exhausting and almost always the stuff of never improving patient and doc experience. A constantly overwhelmed chicken without a head environment is no way to achieve quality, safety, joy
The author of this ‘letter’
subject of never ending funding fights for us. It is exhausting and almost always the stuff of never improving patient and doc experience. A constantly overwhelmed chicken without a head environment is no way to achieve quality, safety, joy
The author of this ‘letter’
19/
.. on behalf of we primary care docs (#thisisgeriatrics, #tweetiatriciand, #proudtobeGIM #IMProud) is dangerously close to walking away … and it really would be a crying shame. But staying in a system where the right minded art and social importance of this work is not
.. on behalf of we primary care docs (#thisisgeriatrics, #tweetiatriciand, #proudtobeGIM #IMProud) is dangerously close to walking away … and it really would be a crying shame. But staying in a system where the right minded art and social importance of this work is not
20/
supported accordingly may not be sustainable - I feel plaque buildup &dysplasia of cells happening each day
Won’t truncate my time - think all my colleagues agree
Begging all those w influence - start looking at &treating primary care differently
Long game, never short
supported accordingly may not be sustainable - I feel plaque buildup &dysplasia of cells happening each day
Won’t truncate my time - think all my colleagues agree
Begging all those w influence - start looking at &treating primary care differently
Long game, never short
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