The Real Kerfuffle


Why have we not had progress in health access for decades? How is this related to "kerfuffle" or a commotion or fuss? The Real Kerfuffle is the commotion caused by various leaders who talk about health access and represent themselves in favor of health access while they distract our nation from health access by their kerfuffle.

This recent communication was received by "the faithful" from the leader of the family medicine board that determines FM certification. Maintenance of Certification exercises have been under attack for good reasons - limited value despite a great deal of time, effort, and cost by physicians. Internal medicine has made changes based on the evidence. Family medicine has not. In fact, FM leaders appear to avoid the evidence that is all around family physicians.

"My year as Chair of the Board has been very interesting, and I believe productive. Despite the kerfuffle in the press about MOC, the overwhelming majority of family physicians continue to participate. This is not surprising since the certification requirements for family physicians have not substantially changed over the last 45 years. My last letter committed the ABFM to make certification more relevant and helpful to all of us. I think we are getting closer. I hope that you will be able to value the ABFM as your partner in improving your patient care and assisting you with your desire for life-long learning." Sincerely,  James Kennedy, MD  Chair, ABFM Board of Directors

Further Comment

The kerfuffle is not press or media related. The commotions are being raised by FM doctors. We know that there is a lack of evidence basis in Maintenance of Certification. We know that their are boards with more relevant leadership that appear to understand evidence basis a bit more.

The evidence indicates that FM doctors continue to participate because they are forced to participate. The evidence indicates that the certification requirements have changed substantially with more cost, more effort, and more time required by us as compared to an exam taken every 7 years. Family physicians have endured the chaos of this costly experimentation far too long. The interactions between family physicians and their patients are scarcely touched by anything save learning efforts based on more interactions.

What is relevant to improving family practices is not more kerfuffle constructed by FM and other leaders such as MOC, PCMH, HIT, EHR, P4P, MU, ACA, or MACRA. Life-long learning relevant to us must always be about learning specific to our patients and about their situations, their communities, their growing complexities, their needs, and how we can best deliver care to them despite the obstacles from CMS, insurance, and health care designers - including FM leaders. 

It is family physicians that stay and deliver continuity care while attempting to maintain the same teams and optimal quality without the necessary support. They could do with less distractions and more support.

A stronger FM is build by a focus on more pay for office codes such as 99214 and less distraction – less paid by our practices on areas other than delivery of care, less time from us away from care, less effort on meaningless exercises. Family physicians must focus upon value in the eyes of our patients. Leaders of FM must focus on the same values as those that they are supposed to represent.


We also need CMS leaders to put their money where their patients are and where care should be: 

"We need to be sure that the delivery system provides enough capacity in primary care, especially in rural and targeted urban areas," said Slavitt (acting administrator for CMS).  

Hopefully CMS will realize that they are the reason for shortage areas and lack of capacity for health access. Then they can actually address basic health access for the 40% of Americans behind by CMS design.

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Blogs indicate that primary care can be recovered and should be recovered.


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