Family medicine in the US has always had a transactional component to it. Before insurance managers and actuaries determined what family physicians could charge for their services, fees were local and controlled by physicians themselves, based on relationships with patients and community standards.
The fee-for-service model of payment decimated family medicine during the pandemic. Patient visits almost disappeared for the first year and became heavily virtual over the next. Medicare and insurance companies could not agree on how to pay for ‘e-visits’. The result was ‘no patients, no money’. Practices lost long-time staff, laid others off, and saw continuity with patients destroyed. All the while family physicians functioned as community-engaged clinicians working in the hardest places in society with little PPE, having to rebuild their offices while dying of COVID-19 at a rate that exceeded all other specialties.1
I was an assistant in general practice 44 years ago in Glyncorrwg.2 During that year, many GPs I met would take me aside and ask ‘do you really charge your patients to see you in the US?’ and would shake their heads when I said, ‘of course’. ‘How can you do that?’ was their retort. It was unimaginable to them then, but now it appears to be part …
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