AAFP is "Pawn" In Health Care Reform?

I just read this very interesting point/counterpoint piece over on the website of the American Academy of Family Physicians. As you may or may not know, I am a proud Family Medicine Physician. And, yes, I am (still) a dues paying member of the AAFP. I owe a lot to the Academy including introduction to organizational medicine as well as leadership training as a medical student, family medicine resident, and now.

The post I read was in their letter to the editor section and it was called "AAFP Is 'Pawn' In Health Care Reform; Academy Says 'Not So'. The first letter is from former AAFP president Michael Fleming, MD. I first met Dr. Fleming when I was a medical student and I have always respected his opinion - especially on policy issues. Here's what he says:

As someone who has been involved with advocacy for many years, I'm writing to express my brutal disappointment in the AAFP's positioning and effectiveness in the recent health care debate. Although family physicians are in critical need of advocacy for their issues -- payment reform, a repeal and permanent fix for the sustainable growth rate, liability reform, recognition of the value of family medicine, graduate medical education reform, etc. -- the AAFP seems to have become more enamored of photo opportunities at the White House than the needs of members.

In my opinion, the AAFP has been used by most of Washington as a pawn in a $2 trillion chess game -- and the pawn can never win. The AAFP could have taken the high road of quality care for patients and fair payment for the most valuable health care providers. Instead, the organization has gone "all in" for one highly partisan bill that will have absolutely no effect on the issues I listed above. The organization and its leaders need to take a close look at themselves and be reminded of the reason the AAFP actually exists: to meet the needs of its dues-paying members.

The counterpoint to this letter is from current AAFP President Lori Heim, MD. This is also someone I have known for a long time and whose opinion I have always respected. The AAFP Board, to their credit, whether you agree with them or not, has been clear in their position. Here's what she said:

I appreciate Dr. Fleming's point of view. But when it comes to health care reform, we have to remain true to the path the AAFP Congress of Delegates approved. We must hold on to the AAFP’s long-standing principles of health care for all, a system founded on appropriately paid primary medical care, and a replenished pipeline of family physicians.

Although not the end game, the health care legislation currently in Congress takes important steps in that direction. It expands coverage to more than 30 million Americans. With its 10 percent Medicare bonus for primary care physicians and pilot testing of the patient-centered primary care medical home, it embarks on reshaping our health delivery system based on primary medical care. And it invests in primary care training by expanding scholarships and student loan forgiveness programs for medical students entering primary care.

Certainly, the legislation misses the mark in some areas. But the AAFP's work in shaping health care reform has put family medicine in good stead for future legislation that will address, for example, the flawed sustainable growth rate formula and potential reform to the medical liability system. Far from being a pawn, the AAFP has been able to shape the legislation, which shows the first recognition of the value of primary care. Nothing is perfect. But we must make a start. The best start we've had in 16 years is the legislation now before Congress.

Now, before you predict some kind of wishy-washy "on the fence" opinion post from me, this may surprise you. It's no secret that I am disenchanted with organized medicine these days - whether it be AAFP or the AMA - or whatever. I wrote about it in October 2009. I think a lot of physician organizations are having debates like this one.

What do I think? Well, in my book, tort reform (ie - liability reform) and having a fix to the flawed sustainable growth rate are important to me and, I think, important to a lot of dues paying members of physician organizations - not to mention the potential negative impact the proposed legislation would have to physician small business owners (those who have not been swallowed up yet by corporate health care systems - or those physicians who already work for government agencies).

Whatever finally happens, if anything happens with this legislation, I believe that these national physician membership organizations will have used a lot of political capital that will be very difficult to get back. In my opinion, it has already been kind of showing itself in a decreasing number of practicing physicians joining professional organizations, and even some leaving these professional membership organizations.

In other instances, state chapters are distancing themselves from their national organizations. For example, the Ohio State Medical Association (which is the state chapter of the American Medical Association), has all but come out against the current AMA position on the known health care reform drafts. When it is all said and done, will it have been worth it for these national organizations? Well see....

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