Shawn Martin’s Post

From my small and humble observations, what appears to have happened is insurance, pharmaceuticals, and politicians are in bed together and many good hearted well intended individuals who went into healthcare to make a difference are systematically brainwashed through the education system into thinking they are mini gods and simultaneously lied to and not taught many basic preventative health principles, only what drugs to prescribe, then incase that didn’t work to make them a glorified pharma sales rep, a system was designed where the doctor can only have about 2 minutes with the patient so even if they have the utmost integrity and good intentions they won’t have the time to actually help or figure out what is going on. It is astounding and difficult to comprehend how technologically advanced and simultaneously barbaric our system and practices has become. Patients are humans, not dollar signs. Greed has caused intentional failing to provide the training and tools needed for the doctors to be able to fully succeed and help. The industry has made a mockery of doctors. People have lost trust. Logically any smart doctor with integrity figures that out and suffers or leaves.

I have worked as a pharmacist in a primary care setting for over 20 years and could not agree more about the investment needed in this space and your list of needs. We need more physicians, but we need more other players on the team. Primary care needs to be a team-based approach. From your list, pharmacists are the most accessible health care professional, but are extremely underutilized. The general public trusts and has established relationships with their pharmacist. Yet there is no incentive for pharmacists beyond dispensing medications (a misaligned incentive at best when it comes to true patient health). As the primary care investment is made, it should include ways to incentivize the whole team and reward teams that do it well/right.

Health starts before birth in the mother and in her mother. Then at birth and for the first months and years of life, we have a chance to reshape environments and development up til age 8 when the velocity of learning slows. The life experiences over decades are shaped by the beginning, and shape outcomes in ways that a few minutes a year with a primary care team member cannot change. This is particularly true where literacies are less and virtual, digital, smart phone, and other literacies force the need for most and best delivery team members. But the designers specifically shape fewest and least - the opposite of what is needed. Value based is not going to be much more than cost cutting as in 40 years of previous designs. Cost cutting and micromanagement is all that the current designers know and it is what they are training their replacements to do. They also know that to survive, they must not cut big health doing best - so their cost cutting can only harm those not biggest, those most vulnerable, and those doing basics- like us.

Agree 1000%! Don’t forget there are many like-minded, highly competent and experienced PAs impassioned to help. As Family Medicine clerkship faculty, educating and inspiring medical students to pursue primary care careers for 15 years, I even hired a former med student as my supervising physician. We precepted numerous medical students in our family medicine practice over the years. Yet I wasn’t allowed to access AAFP resources because we are lumped together with NPs who often seek independent practice (Shout out to my wonderful STFM colleagues who embrace interprofessionalism!). Primary care PAs are allies, not adversaries, and we highly value team-based care + our relationship with SPs. Let us fill some of the gaps, to help every person access the primary care home they deserve.

To quote from a 1979 DICP article THE CLINICAL COMMUNITY PHARMACIST-a proposal by a Family Practice Physician (well ahead of their time): "A study by Bass points out what all community pharmacists are well aware of: they are providing a significant amount of primary care service to patients, especially when there are access barriers to physicians, and this service is more significant for those pharmacists in communities. To ignore this existing primary care role would be a disservice to the future of pharmacy and to those segments of the population needing greater access to health care services." We do not have another 45 years to embrace the role of the primary care pharmacist practitioner, that is all ready located in our communities (in bricks and mortar), serving our communities. Having wait times of 26 plus days to see a PCP is unconscionable in a modern society. The misaligned reimbursement models must be addressed to capitalize on this valued resource that is doctorally educated and able to serve this unmet need. All we need to do is look to Nova Scotia for such a model....

I agree but this biggest barrier in my opinion is lazy and or opinionated physicians thinking just because they went to medical school they know everything not to mention they think they so clearly know what is best for every patient even if they've been proven wrong time and again. Especially in the case of chronic pain. A good number of idiot physicians still think long term chronic pain still should not be treated with opiods, EVEN WHEN THERE IS STILL NO OTHER SAFE, RATIONAL OPTIONS AVAILABLE. It's idiotic and should be considered severe malpractice as the number of suicides, broken and destroyed families and patients is unquantifiable because there are so many. Doctors act as if pain is just something patients can ignore or think away yet they don't expect it to be done in surgery, Emergency Rooms or elsewhere but if you have a long term chronic disease that will destroy your body, soul and will to live without treating the pain adequately, to most practitioners it's simply not a big deal. It's always blown my mind the attitude so many anesthesiologists take like pain is no big deal unless a surgeon is cutting you with a scalpel. THE lack of knowledge and simple common sense is outright shocking. Malpractice ^99999^999999

I find it fascinating that primary care leaders won't engage with the very simple and well-supported (with reason & evidence) notion that primary care should not be paid for with insurance. Third party payment is the reason primary care is in crisis, that physicians are suffering more every year, fewer med students are choosing primary care, and it cannot fulfill its objectives. I talked about "investing in primary care" here. Please listen and let me know what you think. https://cms.megaphone.fm/channel/nurturing-heart-of-family-practice?selected=MOTO8345855240

1. Primary care is a common good. Family physicians reflect the common good that should support basic human infrastructure as well as physical infrastructure for a more efficient and effective nation. Our nation does not support the common good - the people who serve are compromised, particularly where they face the most complexity and are most needed. Family physicians are most abused by lowest payments in the states, counties, and vast regions of the nation where they are most important - and are paid less.

In 2023, if either the President of the National Alliance of Health Care Purchasers or all of the Presidents/Executive Directors of their 24 Employer Coalitions/Business Groups were contacted by you, they would agree with you: as would the CEOs of Elevance, UnitedHealthcare, and most HMOs. In 2023 forward organizations like Morgan Health and Centivo, as well as the Coalitions and Insurers, are touting "AdvancedPCP" as THE Solution to Employer-driven US Healthcare Costs. So just contact them to discuss your Solution, because you clearly don't need LinkedIn advice to "sell" your ideas. AdvancedPCP is already sold to the Decision-making Payers. With the likely shortage of Internists and Family Practitioners as well as what likely will be the need to increase their income based on Supply and Demand along with addition workload in the mid2020s, the need for discussion is urgent. Go for it and Have a successful 2024!

When our nation valued the common good as in the late 1960s and 1970s, family medicine flourished along with most Americans most behind. Our nation and its designers supported a one time buildup of hospitals, practices, basic health access, and locally focused health care leadership You can also see the one time buildup of primary care at this time with declines and flat lines since that time except when medical students were scared into primary care and away from hospital based specialties in the managed care panic. Our fate is linked to the common good. People demanded and got family physicians. It appears that voices for the common good are drowned out and health care is a great example. Those who drain the treasuries drown out the common good in the US and in health care.