The other day I heard a Yale professor talk about Hippocrates 400 BC as "Before Current" times. This year's congress of delegates for the AAFP consumed significant time discussing same sex marriage and global warming.
Meanwhile, the AFMRD, AAFP, STFM majorities continue to avoid dealing with the strategic blunders which have weakened family medicine. Weakening of the residency standards has weakened the right to practice emergency medicine and obstetrics. These weaknesses have significant implications downstream from training. They are career changers.
As some of you may or may not know, I have been an outspoken critic of these strategic blunders because I feel they diminish the quality of care received by patients. In the debates,some used ad hominem tactics,labeling me as a"proceduralist" who pursued illusions of surgical grandiosity.
Unskilled in academic obfuscation, I publicly stated that they suffered from an epidemic of "IQ reductase" and "craniorectal inversion". Unfortunately, physicians who felt differently ascended to positions of political and academic power, particularly here in Tennessee, where I referred to them as the peckerwood factor. Mea culpa. I apologize.
Subsequently I was placed in the academic witness protection program, and have remained peacefully out of sight posing as a Panamanian physician, Mondo Sigmo MD, who spoke only Spanish while practicing surgical family medicine obstetrics+ER. Unfortunately, my cover has been blown by a former resident who unwittingly said something nice about me and then published it[Fam Pract News Oct 1, 2011:18].
Yes, proceduralists are dedicated to the behavioral arts in medicine. It is when the physician shows up at the bedside 0400 for emergencies and deliveries that they continue the tradition which earned the privilege of a profession. You can pretend to care, but you cannot pretend to show up.
Revisionists can gerrymander votes and distort facts, but a substantial minority of family physicians still maintain the freedoms granted to us by Pisacano and generations of physicians who preceded us.. I will be leaving my current witness protection program, and assuming a new identity as Endoscopic Elvis[El Vez de Endoscopia MD] November 3-4 in Memphis. Please keep it quiet.
Thanks.
EE MD
Yes, the draft RRC requirements (which are on hold except for the OB ones) has a two tiered systems (basic OB – 20 deliveries vs competency – 80 deliveries). I have real heartburn with the 80 numbers as many hospitals have granted privileges at 50 deliveries, a large number of our grads with 50-80 deliveries are still out there practicing OB and were quite competent to do OB with numbers shy of 80.
I fear we are losing ground by setting the bar higher and losing programs that will be graduating “OB-competent” family docs. I have raised this number issue with Jim Martin (who is on the RRC) but they negotiated this with the OB RRC without any input from PD’s or the STFM procedures group – a grave error in my opinion.
Michael L. Tuggy, MD
If that is true, then it sometimes seems that our organizations are our worst enemies....
And at the AAFP conference the staff manning the ABFM booth advised me that they were aware of no problems or concerns RE the maintenance of certification modules.
Sincerely,
Dan S.
Well, they sure heard about the disgust from me and several times. What a farce. Has everyone written to them? We are far too silent. I heard Puffer got booed off the stage at one of his presentations. I’ve not heard a single FP feel the current SAMS, etc, are valuable. And it’s interesting that one of the reasons for them is “to assure the public they are receiving competent and up to date care”.
Those units do not promote quality, just a big financial bottom line for the Board. Sad. Yes, our own are our worst enemies.
Jack Pfenninger
(Sorry if I’m getting on a political trip here, but, we are lambs here when we need to be lions and just say no. So, I’ll make this oriented for this group: Do you see anywhere where any of even the basic procedures are being taught in the SAMS units? We could sure get some improved quality of care if they were!!!)
Well said Jack, and every time we play the numbers game with the sub specialists that number will continually rise as it has done with endoscopy. The majority of FPs are competent after 50 and I am sure there are some OBs that are still not competent after 80. Those of us who work with programs that deal with physicians in trouble know that. The problem I see is that as the specialty colleges raise the numbers to limit a falsely conceived competition from Family Physicians in the urban centers they directly impact the production of OB Trained residents who plan to enter the rural areas of the country. We have many rural areas here in the West where the only OB care is by Family Physicians and you couldn’t afford to supply an OB to those areas even if they were willing. Further siloing of procedures by specialty organizations only further limits access to many of our most vulnerable citizens. We are faced now with more patients in the system than all of us combined can even begin to care for, and on top of that have policy makers who seek to strip funding to GME or raise the bar out of reach so our only source of producing more help is severely limited. It is mind boggling that there are some still worried they may lose a case because a generalist may do it instead of them. We really need to focus on how we are going to solve access problems to the other half of our population that doesn’t live next to an ivory tower institution or a big metro center.
Tom Told DO FACOFP dist.
Index--RRC, curriculum, OB, ER, Elvis
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