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.



Comments

Post a Comment

Popular posts from this blog

Another Fine CMS You Have Gotten Us Into

Perhaps we are indeed back to the time of Another Fine Mess (Laurel and Hardy). In a mad rush to implement innovation and to save all possible costs, CMS is creating complications for people that it is most responsible to protect. As PBS and Ken Burns celebrate the legacy of The Roosevelts, it is tragic to see what has become of over a century of effort involving Social Security, Medicare, Medicaid, and health care equity. The United States has one of the most complex health designs and clearly the various designers often know not what they are doing to others. More cartoons and comedians would find this a ripe area for material if not for the suffering involved. Health and Human Services has a huge role across Social Security and US health care. CMS or the Centers for Medicare and Medicaid Services has a dominant role to play in the design of health care in the United States.  CMS can be progressive or regressive. Interestingly CMS has chosen to appear to be progressi...
Read more

The Essential True Reform Restores Primary Care and Much More

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about...
Read more

Innovation Is the Problem Not the Solution for Worsening Health

Image
Innovation is good. Innovation worship is not good. Innovation application without scientific testing or clinical trials is unethical regarding clinical interventions and should be just as prohibited with regard to health policy. Clinical trials can harm hundreds or thousands. Innovative policies can harm millions. It takes a reasonable understanding of health care, health care outcomes, social determinants, and the investments that most improve social determinants to understand the consequences arising from the innovative nightmares past, present, and future. If you review the information sources with a critical eye, you too may find that the innovative policy designs have been disruptive to care, have hurt health care where health care is most needed, have reduced access to care, and have resulted in distortions in the literature. Indeed what is accepted and published in journals seriously lacks consideration of alternative hypothesis, lacks inclusion of many pages of limitatio...
Read more