Focus on Supportive Designs to Fix Burnout

While promoting the new well-being efforts at AAFP, the promotional material indicates what AAFP must address to result in improvements in well being for family physicians. "To function at your best in an ineffective system" would first of all require AAFP to lead the nation to address the ineffective system. Top on the AAFP list should be all resources focused upon the grossly insufficient investment in primary care. Also high on the list should be efforts to address insufficient investments in people, families, and communities for best health outcome results. Attending a conference may not work out for well-being as those who attend will return to an ineffective system. 

The following critique is directed at the latest AAFP efforts to address family physician well being by web sites, live chats, and well being conferences.

I learned during my time as an AMA Delegate that association activities were often turned into parties for those most associated with the association. I do not think that the AAFP plans a party, but it is certainly planning a conference that cannot possibly address burnout where it has to be addressed.

Those Who Attend Conferences

Those who attend are likely to be employed with CME allowances. They have other backups and supports (best insurance, colleagues, employee assistance, job duty flexibility).  

Tally Up the Costs For Those Most Burned Out

The small practice family physicians stand at the front lines of health access. They have also had the greatest adjustments required. Their margins are lowest due to lowest payments and greatest cost of delivery increases.

Consider that those most in need of rest and recovery are most likely to be in small practices and self employed and have the following un-reimbursed losses to consider
  • AAFP Membership $740 
  • Conference $800
  • Plane fare $300 to $600 per person
  • Hotel $1000
  • Lost revenue $10,000 - one week of 50 weeks a year at $500,000 revenue a year - Note that they will have to make up this revenue if they go, worsening burnout.
The situations and costs demonstrate that well being conferences have little hope of addressing the well being of family physicians most in need of well being. 

Conferences Are Great - for those who Plan Conferences and Go to Conferences to Further Careers

Perhaps the most likely benefit will be that well being efforts and conferences will encourage and establish association and academic careers focused on physician who may well-being. Sadly this too will add more distraction rather than specific focus directed to  changes that would address well being and the inefficient and ineffective system that results in burnout.

Addressing Burnout and Well Being
  • AAFP should focus on equity in payment for the same services. Never should it have tolerated15% less for practices where 30 - 40% of family physicians are found. This would be $75,000 more a year in revenue generation per family physician. The benefit could be as much as $90,000 a year more with the overall impacts of better financing on team members, productivity, reduced turnover, and more time to interact with patients, team members, and family.
  • With equity in collections for a boost of $25,000 to $50,000 per family physician per year plus equity in payment, family physicians could afford to go to a conference or two - and they would not need a well-being conference and they could choose a relaxing vacation of their choice.
  • A focus on Triple Threat is required to address burnout and to improve well being along with improving almost everything about being a family physician. The fight must focus upon revenue too low and cost of delivery accelerating along with complexity. 
  • Associations should hold the current political administration accountable to reduce meaningless us - as they have promised to do. There is no reason not to point out that MedPAC has advised termination of MIPS and CMS needs to do so.
    Digitalization, certification, and regulation have subtracted $30,000 to $50,000 which would also allow sufficient time for a nice vacation and more team support.

If not evident by now, it is the financial design that results in stress, burnout, lower productivity, higher turnover, and other practice consequences.

Associations should support those who can make needed changes so that most family physicians have more support, have more to share the load, and benefit from reductions of meaningless complexity

Red Zone Specialties are most likely to plan to leave their current practice and are most likely to plan to reduce hours. This is linked to burnout. The Red Zone specialties are the most numerous, the most basic and lowest paid, the most important for health access,  and are about 85% of services where lowest concentrations of physicians are found.


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