Re: Spiritual leader of IMP movement?

July 12, 2007

Nice

article! Congratulations Moitri, I’m glad things are going well! However,

Dr. Bagley’s comments really make me mad. In his simple statement, he quickly

disposes us as a fringe movement within family practice and suggests that if

all docs did this it would actually harm the

country by increasing the shortage of primary care docs. In my mind, with those

words, the tone of the article shifted from “Wow, this is cool” to “oh,

well, it sounded cool initially.”

If the Director of Quality (and Past

President) for the AAFP finds our movement “hard to support,” how

is it possible to get the support of our local colleagues? How can he be so

small minded not to see that the current trend shows few US Med grads going

into FP—so unless something radical is done (like, I don’t know,

the IMP movement) FP will essentially cease to exist? Gordon, should we send

him a letter or something giving our point of view?

Spiritual leader of IMP movement?

I didn't see this posted yet:

http://www.latimes.com/news/nationworld/nation/la-na-doctors10jul10,1,7110411.story?coll=la-headlines-nation

(may have to copy and paste into browser window)

Congrats to Moitri and Gordon! Article came out

yesterday in Los Angeles Times.

I am seeing more and more about this model in the

press, and more colleagues are asking me about it -

feel like this movement is gaining momentum!

Rancho Mirage, CA

IMP since 10/05

__________________________________________________________

Food fight? Enjoy some healthy debate

in the Yahoo! Answers Food & Drink Q & A.

http://answers.yahoo.com/dir/?link=list & sid=396545367

July 12, 2007

Ron,

I have been told by some NASA engineers that

in the 60s when we decided to beet the Russians to the moon, there was a huge

push to produce engineers. Young kids were encouraged to go into engineering

and they knew they had good jobs and the satisfaction of knowing they are

fulfilling their patriotic duty at the back end. In response to this, there was

a huge increase in the number of engineers produced, and the rest is history.

We are now running into a similar issue in

medicine with a huge wave of increasingly elderly patients and a diminishing

pool of primary care docs. There are multiple potential solutions to the

problem. A large insurance/hospital nonprofit in the area sees the future as a

clinic with 10,000 patients 4 NPs and a supervising FP. Dr. , up the

road from me, believes by increasing overhead to the max and only doing what is

absolutely necessary for a doc to do and thus seeing 60 patients a day helps

address the issue. The problem, as Gordon points out, is that no other solution

really makes primary care fun. On the

contrary, all these solutions increase the drudgery of medicine without

strengthening the doctor-patient relationship. The result of that is to

continue to perpetuate the myths that 1) Primary care is no fun (after all, no

one I know in primary care is happy) and 2) Anyone can do it (they only went

into it because we could not get into anything else). When pre-med and med

students see that, they will continue to run away. My point is that unless primary

care changes (and only part of this is financial), the crisis will get worse,

not better. The solution to the problem is to make the job enjoyable and

financially sustainable (including being able to pay off med school loans) and

then marketing the hell out of it (Be a patriot, Be a

Family Physician). If we do this right, in 7 years we will have a huge crop of

new excited and fresh FPs.

Spiritual leader of IMP movement?

I didn't see this posted yet:

http://www.latimes.com/news/nationworld/nation/la-na-doctors10jul10,1,7110411.story?coll=la-headlines-nation

(may have to copy and paste into browser window)

Congrats to Moitri and Gordon! Article came out

yesterday in Los Angeles Times.

I am seeing more and more about this model in the

press, and more colleagues are asking me about it -

feel like this movement is gaining momentum!

Rancho Mirage, CA

IMP since 10/05

__________________________________________________________

Food fight? Enjoy some healthy debate

in the Yahoo! Answers Food & Drink Q & A.

http://answers.yahoo.com/dir/?link=list & sid=396545367

July 12, 2007

I believe Albert Einstein said it best when he said:

" Great Spirits have always encountered violent

opposition from mediocre minds "

Wilmington NC

--- " Brady, MD "

wrote:

> Nice article! Congratulations Moitri, I'm glad

> things are going well!

> However, Dr. Bagley's comments really make me mad.

> In his simple

> statement, he quickly disposes us as a fringe

> movement within family

> practice and suggests that if all docs did this it

> would actually harm

> the country by increasing the shortage of primary

> care docs. In my mind,

> with those words, the tone of the article shifted

> from " Wow, this is

> cool " to " oh, well, it sounded cool initially. "

> If the Director of Quality (and Past President) for

> the AAFP finds our

> movement " hard to support, " how is it possible to

> get the support of our

> local colleagues? How can he be so small minded not

> to see that the

> current trend shows few US Med grads going into

> FP-so unless something

> radical is done (like, I don't know, the IMP

> movement) FP will

> essentially cease to exist? Gordon, should we send

> him a letter or

> something giving our point of view?

>

> Spiritual leader of

> IMP movement?

>

> I didn't see this posted yet:

>

> http://www.latimes.

>

<http://www.latimes.com/news/nationworld/nation/la-na-doctors10jul10,1,7

> 110411.story?coll=la-headlines-nation>

>

com/news/nationworld/nation/la-na-doctors10jul10,1,7110411.story?coll=la

> -headlines-nation

>

> (may have to copy and paste into browser window)

>

> Congrats to Moitri and Gordon! Article came out

> yesterday in Los Angeles Times.

>

> I am seeing more and more about this model in the

> press, and more colleagues are asking me about it -

> feel like this movement is gaining momentum!

>

> Rancho Mirage, CA

> IMP since 10/05

>

__________________________________________________________

> Food fight? Enjoy some healthy debate

> in the Yahoo! Answers Food & Drink Q & A.

> http://answers.

>

<http://answers.yahoo.com/dir/?link=list & sid=396545367>

> yahoo.com/dir/?link=list & sid=396545367

>

________________________________________________________________________________\

____

Yahoo! oneSearch: Finally, mobile search

that gives answers, not web links.

http://mobile.yahoo.com/mobileweb/onesearch?refer=1ONXIC

July 12, 2007

In these cases would it be helpful to issue an IMP listserv " call to

action " ? For example, provide the contact info for both the person

quoted, and the journal editor...if they get 100 " animated " and

thoughtful responses from physicians on this list, it could change their

opinions forever.

Cyrus Peikari, M.D.

P.S. has anyone else noticed the " digest " feature has stopped working on

this listserv? I have confirmed this with a couple other people on this

list, and Googling shows some people in other Yahoo listservs have the

same issue.

Brady, MD wrote:

> Nice article! Congratulations Moitri, I’m glad things are going well!

> However, Dr. Bagley’s comments really make me mad. In his simple

> statement, he quickly disposes us as a fringe movement within family

> practice and suggests that if all docs did this it would actually /harm

> /the country by increasing the shortage of primary care docs. In my

> mind, with those words, the tone of the article shifted from “Wow, this

> is cool” to “oh, well, it sounded cool initially.”

>

> If the Director of Quality (and Past President) for the AAFP finds our

> movement “hard to support,” how is it possible to get the support of our

> local colleagues? How can he be so small minded not to see that the

> current trend shows few US Med grads going into FP—so unless something

> radical is done (like, I don’t know, the IMP movement) FP will

> essentially cease to exist? Gordon, should we send him a letter or

> something giving our point of view?

>

> -----Original Message-----

July 12, 2007

We're a disruptive innovation (see 'The Innovator's Dilemma' Clayten

Cristiansen, Harvard Business School Press 1997).

Bruce Bagley is a good guy, so I can't imaging that his response is based

on anything other than the difficulty presented by a disruptive

innovation.

We'll get this kind of response often, but don't let it depress or

suppress you. We've got a better mousetrap & we're continuing

to move ahead with solutions for some of the big problems we still face

(namely adequate financing for doing the right work).

Bagley does make the very reasonable point regarding primary care

physician shortage.

From my perspective, this shortage stems from the paucity of those

choosing primary care as a career choice. This is likely due to the

manifest misery demonstrated by so many in primary care practices coupled

with the ever worsening environment for primary care.

The solution to primary care shortage is to demonstrate an attractive

primary care practice model. As far as I can tell, we're the only

action on this front. Keep up the good work guys. We're right

on track.

Gordon

At 12:12 AM 7/12/2007, you wrote:

Nice article! Congratulations Moitri, I’m glad things are going well!

However, Dr. Bagley’s comments really make me mad. In his simple

statement, he quickly disposes us as a fringe movement within family

practice and suggests that if all docs did this it would actually harm

the country by increasing the shortage of primary care docs. In my

mind, with those words, the tone of the article shifted from “Wow, this

is cool” to “oh, well, it sounded cool initially.”

If the Director of Quality (and Past

President) for the AAFP finds our movement “hard to support,” how is it

possible to get the support of our local colleagues? How can he be so

small minded not to see that the current trend shows few US Med grads

going into FPso unless something radical is done (like, I don’t know,

the IMP movement) FP will essentially cease to exist? Gordon, should we

send him a letter or something giving our point of view?

July 12, 2007

Well, we should not be so offended by this question: it is a valid question. We IMPs

mainly focus on what is good for us as individuals (ie: # hours/week WE want to work, and

what public health coverage we wont accept because they pay poorly) and

on what is good for our patients (they DO enjoy a doctor who LISTENs to them and spends

necessary time to be comprehensive, thorough) BUT, that does not answer the challenge

of how this country (or any other in the same type of bind) can provide sufficient manpower

to attend to all its members, a public health issue. Certainly adequate screening and triage

plays a large role here (determining which patient percieved problems really need expert care,

which can be managed by lower level care, and which really need to be dealt with with patient

education/lifestyle change). This is a real problem and one which we need to recognize. I am

not sure personally how the IMP model can speak to this issue. I know that several listserve

participants have been trying to make IMP fit the public health delivery challenge and that Gordon

has been looking at it also, but dont know what success or progress or recommendations

are coming forward. It is, I feel, one that we need to address. Ron

Nice article! Congratulations Moitri, I'm glad things are going well! However, Dr. Bagley's comments really make me mad. In his simple statement, he quickly disposes us as a fringe movement within family practice and suggests that if all docs did this it would actually harm the country by increasing the shortage of primary care docs. In my mind, with those words, the tone of the article shifted from "Wow, this is cool" to "oh, well, it sounded cool initially."

If the Director of Quality (and Past President) for the AAFP finds our movement "hard to support," how is it possible to get the support of our local colleagues? How can he be so small minded not to see that the current trend shows few US Med grads going into FP—so unless something radical is done (like, I don't know, the IMP movement) FP will essentially cease to exist? Gordon, should we send him a letter or something giving our point of view?

-----Original Message-----From:

[mailto: ]

On Behalf Of flores chrisSent: Wednesday, July 11, 2007 8:22 PMTo:

Subject: Spiritual leader of IMP movement?

I didn't see this posted yet:

http://www.latimes.com/news/nationworld/nation/la-na-doctors10jul10,1,7110411.story?coll=la-headlines-nation(may have to copy and paste into browser window)Congrats to Moitri and Gordon! Article came out

yesterday in Los Angeles Times.I am seeing more and more about this model in thepress, and more colleagues are asking me about it - feel like this movement is gaining momentum!Rancho Mirage, CA

IMP since 10/05__________________________________________________________Food fight? Enjoy some healthy debate in the Yahoo! Answers Food & Drink Q & A.

http://answers.yahoo.com/dir/?link=list & sid=396545367

July 12, 2007

What about market forces and supply and demand? If a huge primary care

deficit ensues, then maybe the market will actually pay more for primary

care (HAH!). Could be a few lean years for the country in between when

supply catches up to demand. I would say let the market work. Isn't that

(supposedly) how this country operates?