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As a Family Physician in practice for 44 years, 13 in a group of Family docs, 10 years in "institutional medicine", and the past 18 as a solo doc, I 100% agree with Dr. Strange. My experience in the first 13 years of practice was along the lines of his model. The cracks in the Family Doc providing relational, ongoing, take-enough-time care began in 1985 (in the Seattle-Tacoma area) with the local Blue Shield plan offering us 85% of "usual and customary fee" if we joined their network...which all of us had to do in order to refer to the secondary specialists as we had been doing, and because doctors are not allowed to share reimbursement information (anti-trust...anti - "trust"). That is now ~25% discount on disproportionately lower fees than the secondary specialists command.
My one question to Dr. Strange is this: How?
Convince docs to leave hospital-led practices? with no guaranteed salary, no health benefits, no income until patient base is built up...and possibly a non-compete clause to deal with?
Convince students and residents to take up the cause when they face those first three challenges and have massive debts to pay?
My fear is that the Family Physicians who lead the charge to this new (former and better) model of care will end up like the revolutionaries of Les Miserables , plowed under by the combined forces of institutional medicine, health (sic) insurance companies, politics, et al. I devoutly hope not.