A fantastic new study 😉 has once again documented the incredible burden of EMRs on U.S. family physicians. Researchers observed 982 family physician-patient encounters in clinics associated with 10 family medicine residencies. They recorded the times required for the physicians to complete each clinic visit. They did not record times for...
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Family physicians know a lot about a lot of symptoms, diagnoses, and healthcare system issues. I think the AAFP and other FM organizations have generally done a lousy job explaining the breadth of the work we do, but now we have numbers to tell the story better. A study by the...
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In a very unique study, researchers have tabulated how often family physicians provide patient care that is not covered with a CPT code. This is a little complex, for the non-physicians and even for many physicians to grasp, so I will provide a little more background first. CPT stands for Current...
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OK, “myth” is a bit of an exaggeration. A study from 2014 by the Robert Graham Center found a U-shaped relationship between medical student debt and the likelihood of students going into family medicine. Actually, it was more of a saucer-shaped curve. Students who had debt > $150,000, but also those with...
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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to...
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First, I recognize that the whole PCMH experiment was not a total failure. There were some successes. The Patient Centered Primary Care Collaborative (PCPCC) puts out an annual review on PCMH demonstration sites that is always positive. On the other hand, the AAFP PCMH National Demonstration Project was mostly a failure....
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In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Traditional industrial QI does not work in primary care. A recent publication brilliantly makes this case on both theoretical and practical levels ;-). On a theoretical level, primary care is best thought of as a complex adaptive system, not a simple linear mechanical system. Think of complex adaptive systems as kind...
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There was a nice opinion piece in JAMA Internal Medicine recently where the primary author talked about moving from the U.S. to Switzerland and his experience in both systems. Primary care physicians are allowed to bill based on time there. This includes travel time, phone work, and documentation time. What a concept!...
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