Forget just for a moment, the other controversial issues swirling around physician pay such as the GPCI (geographic practice cost index) and the SGR (sustainable growth rate). This is about recognizing that primary care doctors – geriatricians, internists and pediatricians in addition to family docs, have to really think about their patients in a different, more expansive way, now more than ever before.
In fact, Heim says, that level of skill required, and the difficulty involved may much more closely reflect the value now placed on a cardiologist's placement of a stent in a coronary artery or a gastroenterologist's removal of a polyp during a colonoscopy.
"We as the academy are saying there's a problem with the methodology by which we looked at payment for fee for service primary care," she said. Heim emphasized that this is not about saying, "Pay us more," although that is clearly one end result. "We're saying the way we've looked at fee for service, the formula is flawed because it does not recognize the work effort and complexity that goes into it."
AAFP says that if the nation does not want to further erode its supply of its front line physician workforce, it needs to find a way to compensate for this part of their extra workload.
"When the formula for the RVU was set up, the folks who did that did a fairly good job of being able to capture procedures, for example, how much work went into it, how much malpractice risk was there. The current system is pretty good about what that might be worth," she said.