Killing Off Caring Docs That Matter

By permission from Shane A Avery, MD    August 29, 2018 12:47 PM as posted in AAFP News

I am a rural, solo, self-employed family physician who is practicing with his wife, an NP; in one of the poorest counties in Indiana. I was one of the physicians who reported the first cases of HIV during the historic outbreak in 2015. I lobbied at the state level for a needle exchange program when our governor and state health department said it should not be done. It is quite sobering to have the heads of the HIV division of the CDC sitting in your hospital boardroom. I had fought the opioid epidemic before it was recognized, when JCAHO was telling us to monitor pain as the 6th vital sign. I watched a rural community flounder under an epidemic of death, disease, and disability brought on by opioids with the blessing of the healthcare and pharmaceutic industry. But I am a family physician. I kept seeing patients in the office, providing complex care coordination. I did home visits. I did obstetrics and performed cesarean deliveries, until my rural hospital closed their OB department. I still do endoscopy and advanced dermatology procedures, as long as my critical access hospital can maintain a surgery department. I helped fight off a power plant that was to be built next to a school. I work the ER. I still do hospital medicine. I still host 2-4 medical students a year on their 3rd year family medicine rotation. I have practiced healthcare for 19 years independently from birth to grave. I am the dream of family medicine, as envisioned from the 1970's onward.

My wife and I did this while raising a non-verbal severely autistic son with down syndrome. And we have produced 3 adult daughters who are all entering or have entered healthcare: a pediatric nurse, a medical student, and a social worker. I am a physician who still says that healthcare is a rewarding field that should be pursued.

Primary care is changing. It needs to change. We need to accept advanced practice nurses, but we need to work as a team. We need to accept the technological changes, but it must enhance patient care, not hinder it. We need to work as teams, collaborating with larger entities FOR THE BENEFIT OF THE INDIVIDUAL PATIENTS AND THE NATION AS A WHOLE, not for the benefit of an investor, CEO, bean counter, or CMS. We need to accept caps on healthcare spending, but not as part of a carrot vs stick system that demoralizes the providers of healthcare and drives them to suicide. These are the messages that I feel the AAFP need to be promoting and that I think could gain traction as part of a national advertising/lobbying campaign to regain the heart of patient care.

I chose family medicine to make a difference. I believe I have had that opportunity. But we are losing traction. I believe that we (us as family physicians, not the AAFP) will win in the end. Patients still get sick, they need care, and no one can provide it as efficiently as a properly trained family physician. But how many more family physicians must quit or commit suicide, how many more patients must be hurt, how many more rural hospitals must close, before that happens?

The proposed CMS changes will simply destroy what I have left. Plain and simple. We have issued warnings in the past. But there is simply nothing more left to give. We are all at a breaking point. I am currently working in the ER halftime to support my practice. I can't see a future for my practice if these changes pass. I had hope that one day I could spend my retirement training medical students and residents for family medicine. I see little hope for that until the national agenda changes. That is my challenge to the AAFP. Quit negotiating with CMS. Patients and their physicians are disgusted. The public will listen. Congress can listen. Make this a national crisis. Make it part of the 2018 and 2020 election campaign agendas.

From Robert Charles Bowman, MD    August 29, 2018 1:52 PM

I urge you all to share the link to this message with various AAFP groups to read the messages above. Dr. Avery's message tears at my heart.

If there is permission from the authors, this can be shared with wider audiences.

My messages can be posted elsewhere, no problem.

Shane A Avery, MD    August 29, 2018 2:09 PM 

Sure. Share ad lib. I really believe this is a political issue, not a healthcare issue. That is how we won clean needle exchange in Indiana. CMS and "the nation" need to understand what "meaningful use" actually is. I think the time is ripe with high deductible insurance, physician suicide, the loss of ob and rural critical access hospitals, patient dissatisfaction with healthcare, etc... We have an audience.


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