The Discomfort Zone

From the American Academy of Family Physicians (AAFP) Congress of Delegates, San Diego

Family physicians are being told they need to change their practices a.s.a.p. to survive financially. The scope of the tasks they face parallels broader challenges in society, such as the evolution of media and the crisis of global warming. Collectively, I think we’ve all entered what I’ll call the discomfort zone.

The leaders of the American Academy of Family Physicians (AAFP) hammered on a key message at their 2008 Congress of Delegates: primary care physicians must move rapidly to adopt a new model of care called patient-centered medical homes, despite the obstacles. For instance, the definitions of what qualifies as patient-centered medical homes haven’t been finalized. It will involve improving electronic records and e-communication systems, probably with physicians footing the bill, at least initially. Oh, and the new payment systems that will make this viable? Not there yet.


Still, family physicians shouldn’t wait for more money and resources, but must do what they can now to become patient-centered medical homes if this concept is to have any chance of becoming reality, AAFP leaders said. (On the bright side, preliminary results from pilot projects around the country so far suggest that patients and clinicians are more satisfied in patient-centered medical home systems, patients stay healthier, and practice incomes increase. And by the way, isn’t this kind of what Kaiser has been doing all along? So, there are some role models out there.)


“The Academy has put a full-court press toward the patient-centered medical home,” AAFP Board Chairman Dr. Jim King said. “We are defining it, gaining support for it, getting it paid for, and changing to it.” Simultaneously.


The messages seem to be: Change now. Figure out a way to make it happen. Do the seemingly impossible. Realize the vision.


Let’s look at parallels in the media. Print media (newspapers, magazines, journals) are hurting as everything moves online, but the revenue from online products lags. The AAFP is feeling this too – it lost $2.3 million in support from pharmaceutical companies last year, much of that in canceled journal advertisements. The AAFP ended the print version of its AAFP News Now and started charging for print copies of its journal Family Practice Management, though members can get both for free online.

In virtually all of print media (including my company) there’s a rush to develop online products like audio podcasts, videocasts and, yes, blogs despite the fact that revenue streams aren’t well developed for these products. Doesn’t matter. Whether we’ve got the training or tools or funding to do it, we’ve got to change to survive. Make it happen. Realize the vision.


This paradigm plays out most desperately with global warming. It’s already too late to avoid it; all we can hope to do is change rapidly so that we avoid the worst scenarios and loss of life guaranteed from business as usual. Somehow, we’ve got to transform society rapidly to stop using fossil fuels, decrease energy use in general, mass produce renewable and sustainable technologies, and markedly change the way we live.


No one is quite sure how we’ll do this, or where the funding will come from, or whether we’ll succeed. We’re clearly out of our comfort zone here. But we’ve got to believe in the power of the human spirit to perform miracles when needed, and do the best we can.


Change now. Make it happen. Do the impossible. Realize the vision. There are no other options, really, in this age of discomfort.


 —Sherry Boschert

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