As a founding member of the AAGP active from about 1998 to 2004 roughly, and a physician in practice for 24 years, I would like to clarify a few points mentioned in the threads. First, Dr. Harry Watkins is an excellent and caring physician who previously practiced in the small town of Canton, GA, and who saw the need for GPs to have a pathway to BC and single-handedly created the AAGP. I challenge any one to create an organization of this magnitude WITHOUT having some type of funding. The $7000 or so quoted by someone as Dr. Watkins annual "salary" from the AAGP from2008 to 2010- Seriously?! Scams generally involve alot more cash into the millions. His fees were not unlike the fees other doctors pay for their BC and membership, as we know any fee for a doctor will be triple the reasonable rate. His office manager always answered the phone at the Canton office was extremely pleasant and helpful to me, so this is far from a "fly-by-night" operation. As one single person, this is how he chose to generate the necessary capital for this project that devoured huge amounts of his personal and professional time from practice. He should be exalted, not ridiculed, for this achievement. I can see how, as an outsider fed misinformation and falsehoods, some could label this as a scam, but it actually does not meet ANY of the traits for a scam, as I hope to show.
He painstakingly created a pathway to BC for GPs with many prerequisites, including, initially, verification of medical school and post graduate training, a minimum number of years in practice, an unrestricted medical license, and several other items, which had to be notarized and was verified by the AAGP office to the extent possible. The ACGM was created as the certifying body, and the ABGM as the administering body, just like ALL other specialties and was ACCREDITED by the University of Virginia (my memory may be of and it may have been a different one), and I believe the ACGME. The program consisted of 12 "Modules", designated by field of medicine, that were synopses of the expected general knowledge in each specialty that a GP should have for competency. They were similar to the MKSAP series still used by the ACP, but much more extensive, ranging from 100 to 300 pages each. I can attest that it was well written, thorough, concise, and had references for all information contained, such as Cecil's Internal Medicine, etc. There was also a requirement for knowledge of statistics, evidence based medicine, AND heuristics (which none of you even know the meaning of!!, but it the basis for the "practice" of all medicine because it is often an inexact field of science). Each module have an exam at the end of about 100 clinical and basic science questions, which was submitted to the AAGP for grading in order to pass the module. Initially, acceptance to this program (which was not automatic), granted one "board eligible status" IF you completed and passed at least one module every 6 months).
The first board exam was administered in Lake Placid, NY, in 2002, and consisted of a written comprehensive exam AND an oral exam, which no other board has to date. It also required a trip to UC-Irvine in Ca, a very reputable school, for the first ever, and only existing clinical skills evaluation by a medical board in history. It involved 6 mock-patient visits monitored by video cam in each exam room, and professional or amateur actors, well-rehearsed on their presentation, as patients. Again, I can attest that it was vigorous, demanding, and covered 6 of the most pressing issues doctors commonly face, some that have dire consequences if missed. The actors knew their role/symptoms/signs so well, one could not tell they were acting. For example, a patient with chest pain and a normal EKG. I STILL see doctors who rely on the automated reading as 100% accurate, which is very dangerous to the patient. Also, a young girl unsure about whether to get an abortion, a HUGE political/religious/personal issue currently! There was no one correct answer, but mainly how did you handle the situation in the patient's eyes. I WISH this was required of all medical boards, because THIS is what determines a doctor's competency largely, ACTUAL patient care, NOT the well known board exams that even most aweful doctors, you all know some, can pass by studying appropriately. What do patients consistently rank as most important, besides knowledge and competency, IT IS BEDSIDE MANNER!
When Dr. Watkins petitioned the ABMS for designation as a specialty, they declined on the grounds that
general medicine cannot be a "specialty". It fascinates me that now just treating adolescents IS considered a specialty. The AAGP closed the Canton office due to lack of funds. The only act I regret, though understandable and not egregious by any means to me, was that the board finally made a requirement for BE/BC maintenance that you must recruit at least one new member a year, even if, like me, you had paid the fee for "lifetime membership" in the AAGP. In a last ditch effort to generate more members and revenue, he first required BE/BC members to attend at least one annual meeting every 3 years, which I dont think is a scam at all. GPs as a singled out orphaned group should mix with their peers for support.
Also, Dr. Watkins spent great effort to get GPs on the Insurers lists of providers, and did get at least 2 that I know of to do this. Again, for lack of man-power and funds, he eventually had to let it go.
A quick comment on the "mission statement" submitted by someone shortly before my post. This is stating the AAGP
rationale for general practice docs to be give the same opportunity to practice medicine in the US as all other doctors, and not as a statement of already existing factual circumstances. I believe it was targeted to the insurance industry to say that they were essentially acting with prejudice against GPs. Taking both literally and logically, it is a pretty strong argument! While I may not agree with it all, it is ironic that we are given a license that, clearly states, "to practice medicine and surgery" in whatever state designated. I always felt like giving me the "surgery" privilege was errant and possibly dangerous! Perhaps it is historical roots.
On the topic of competency, there is NO evidence that GPs are inferior to BC doctors in the practice of medicine, even when they looked at hospital patients. I believe it is mainly because every doctor's competency depends on HOW MUCH HE/SHE VALUES IT, CARES FOR THE PATIENT, AND THE EFFORT THEY PUT INTO IT. Every physician, and ESPECIALLY the physician recruiters, know that there are good and bad BC doctors and good and bad GPs, PERIOD. Most patients I have seen dont even know what specialty there doctor is, and the inherent differences, or if their doctor is board-certified and what that means. I could have, and wish I had written a book on all the screwups and screwballs I have seen as BC doctors. One surgeon rudely argued that my adolescent patient with fairly classic signs did NOT have appendicitis, and hung up on me. The diagnosis...appendicitis, after took the time and effort to make sure this patient got the care they needed. Some errors are blatant and ubiquitous among doctors. Millions of women with dysuria and positive WBCs and/or bacteria and/or nitrites, are reflexively and robotically given a script for Bactrim or Cipro. I have found a significant number actually have interstitial cystitis, a topic I took the time to research that has documented pathophysiology distinct from UTIs, and now even a specific oral drug treatment.
I have seen BC cardiologists miss loud murmurs, BC orthopedists misdiagnose classic, MRI-proven pes anserine bursitis as MCL strain (after taking 5 seconds to touch the patient's knee), BC neurologist order nerve conduction studies and give gabapentin, for classic meralgia paresthetica, BC IM doctor refer a patient to urology for his routine rectal exam, BC IM doctor missed a chronic large ulcerating BCC on a patient's FACE because everyone just assumed he was demented and digging a hole in his skin, BC GI doctors giving PPIs to prevent side effects from ulcerogenic meds, think buffered aspirin, enteric coated pills are SAFER than non-coated or buffered, because they were apparently too lazy to look at the physiology of it, BC psychiatrist giving seizure patients Wellbutrin, BC surgeons leaving tools and sponges inside patients, and thousands more. I could write a book of errors on EACH specialty probably!
One other illogical practice is the many GPs who have hospital privileges due to grandfathering or other means. Almost every hospital in the US has GPs on staff, so if they is NOW considered insufficient training, they should logically dismiss these doctors! One reason they dont is because they saw that the GPs practiced as competently as the BCs, and there was NO danger to patients. At this moment I am running a private IM practice for 1 1/2 years seeing ALL the patients for the various insurance companies under my partner's name, that the same Insurers may not list me as a provider for. This is illogical in every possible viewpoint!!!
Let me be clear at this point where I stand overall. First, I do believe in the rigorous training requirement for doctors, including the residency, but since BC evolved and is still evolving over time, there are about 10,000 physicians in the US who are not BC/BE "GPs". If removed, roughly 3 million patients would be without a doctor, especially rural areas. As for me, as a Transitional Intern, we were required to do 8 months on the general medicine service with every 4th night call, 2 months of 12 on/12 off ER coverage, and only 2 months of specialty, where I personally did 2 months of every 3rd night call with two orthopedic residents. We did not get any of the specialty/no call rotations that my fellow PGY-1 IM interns had, and provided a much needed break from the call schedule. Ok, I'm not trying to compare machismo with all other doctors who had tough residencies, but we were discrimanated against solely because the programs did not have enough funding or interns to do otherwise. I am currently considering as a last resort right now, to going back to a residency for 2 to 3 years. On a separate point, when I was in California in the 1990's, the medical board gave the one-time, limited time opportunity for all GPs to declare themselves board certified, but they had to have a hospital affiliation at the time which I did not. Also interesting, they had previously given all DOs the chance to change their designation to MD. I suspect this was motivated by the managed cares desire to use BC MDs as the "gold standard" of healthcare, for marketing purposes mainly.
Second, as many doctors have declared, I do not believe in the exam-based MOC/MOL system run by the ungodly wealthy ABMS, who the "doctors4patientcare" organization is currently have a lawsuit against!! If one happens to be a GP, the market will always dictate if you are successful with patients, and even weeds out a few of the really bad ones.
I would also like to comment on the jobs issue. There are still many positions available for GPs, some have been mentioned. One discrepancy I noticed is there are STILL small rural towns that gladly take a GP AND grant hospital privileges, and I still get offers on a regular basis. Another avenue is the CDC and other government agencies that hire doctors under the name of "medical officers", with somewhat lower pay than clinical medicine, maybe $110k vs $140k for a typical GP. Look at
www.usajobs.com. Also physicianjobs.com and locumtenens.com have many GP needs. Also work in foreign countries abounds for GPs, including some very idyllic locations.
As for all the GPs out there, I know the value you have given to healthcare, and I pray that you do not give up your God given talents to help others as we go through what essentially amounts to a complete paradigm shift in the practice of Medicine. Ironically, it is at the time when we face the largest doctor shortage, possibly in US history (I'm sure some historian will correct me on this), and as so many comments stated, I'd rather see a GP than a mid-level.
KM
Atlanta, GA
