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Dr. Stange you voice the thoughts that drove me to explore ways to get back to relationship-based care in 2001. I chose at that time to leverage the concepts ‘lean’ from Jim Womak @MIT, and used technologies to help reduce overhead so that I could remain within the typical insurance reimbursement system while stepping off of the hamster wheel to focus on the needs of patients.
This worked well enough in Rochester NY for the time, though the ever-increasing administrative demands and commoditization of primary care makes this untenable today without exploring alternative approaches to funding.
I’m waiting for the established health care finance system to pay more than lip service for the benefits family medicine brings to society and grow weary of the lack of substantive response to the well-meaning output of committees and commissions. Like Napoleon’s retreat from Russia we are losing too many colleagues and coworkers to the empty coldness of RVUs and metrics focused on body parts.
I join you in recognizing that it is time to stop enabling a dysfunctional system: when we focus on relationship with the whole person we transcend the morass and can deliver on the full scope of family medicine.