President's Letter

Tags: president's letter, jake margo, dr. margo, best laid plans

The best laid plans of mice and men

By Javier “Jake” Margo Jr., MD
TAFP President

I don’t know about y’all, but man, I have really been looking forward to this summer because there’s been something special on my calendar — something I have always wanted to do since I attended summer Scout camp back when I was a kid. For the first time since I became a Scout, I have plans to attend Boy Scout summer camp for an entire week, this time as a counselor! It happens to be at the longest continuously operating Boy Scout camp in Texas, the same camp my grandfather and my father went to, and the same one my son attended as a Cub Scout.

And I also have on my calendar a plan to take my family for a half week of amazing fun at the Boy Scouts of America Family Adventure Camp at the world famous Philmont Scout Ranch in New Mexico. That’s right. I have a plan to introduce my family to one of the BSA’s four high adventure bases. Attending this camp is widely regarded as a pinnacle experience in scouting, particularly by those of us who were fortunate enough to have attended as Scouts.

Well, those were the plans anyway. All of that is canceled now just like the trips and conferences and family reunions we have all planned for this year and perhaps beyond. I’m still going to be a camp counselor for a virtual Boy Scout camp, so all is not lost!

Of course, having to cancel a couple of trips is far from the worst thing in the world. Many of our colleagues across the country are fighting to keep their practices afloat during the most devastating economic event of our lives.

The Larry A. Green Center has been tracking the response and capacity of the nation’s primary care practices in dealing with the COVID-19 pandemic with a weekly survey since the middle of March and the findings have been dramatic. The survey has revealed a “corrosive and debilitating new normal” that pervades primary care, with more than 80% of Texas respondents reporting that the strain related to the pandemic has had a severe or close to severe impact on their practices. More than three quarters say their patient volume is down more than 50% and more than half have laid off or furloughed employees.

Even in these difficult times, it is in my nature to remain optimistic. Right now the entire country is witnessing the bravery and empathy of family physicians in action. As everyone knows, the motto of the Boy Scouts is “be prepared,” and as family doctors, we are truly the most prepared physicians to fight on the front lines against this pandemic.

Family medicine is showing the world the critical role we play in screening for COVID-19 as well as providing ongoing care for acute problems, chronic disease, and mental health problems. Make no mistake; we are at war with COVID-19 and in the fog of war, it is hard to see beyond the battle you are currently fighting. But when we get to the other side of this pandemic, this crisis is going to focus political and public attention like a laser on the role our specialty plays and the need for family physicians.

Your Academy is working hard to capitalize on that focus while also advocating for reforms that would help alleviate the financial strain and administrative burdens practices face. We have proposed a Marshall Plan for Primary Care, the central plank of which is to change payment for primary care from the transactional fee-for-service model of the status quo to prospective payment.

Such a model would mean primary care practices would receive a fixed monthly amount for each patient rather than having to bill for each service provided. Patients would have access to a broad range of services whenever they need care without having to rack up extra out-of-pocket costs, and physicians would see a huge decrease in the amount of paperwork they have to deal with. Imagine we had that in place today. Practices would have a stable, dependable revenue stream and wouldn’t be dependent on churning as many patients through the clinic as possible to keep the lights on.

The plan has generated a lot of discussion and has garnered a good bit of attention in the press. I’m excited about the possibilities we have before us.

As summer approaches, I don’t know what challenges and surprises our “new normal” will bring. I just know there will be more challenges and surprises. And even though I won’t get to show my family the marvels of Scout camp, I’m sure we will find some adventure of our own. As we all adjust to our new reality, I want to take a moment to say a truly heartfelt “Thank You” to all those physicians and nurses and their staff for placing themselves in harm’s way to help care for, ease, and comfort the people of Texas. Thank you and good luck to us all.


  • Greg Willis, MD said

    Probably just old-school, but prefer being paid fee-for-service for what I do rather than being contract labor.

  • Robina Poonawala MD said

    In the early 1980’s , we had a similar plan called Central Texas Health Plan .We were paid per member per month . This also included being a Hospitalist and admitting your own patients.
    A lot of physicians who had enjoyed FFS until then fought it ..
    As a newbie who was starting her practice , I liked being a ‘gatekeeper ‘ and using my skills as a FM physician to tackle a variety of problems that we were trained for but could not use as patients were used to a specialty oriented form of medicine and being able to go to any subspecialists for even a minor ailment ...
    Subsequently they went out of business and we were informed through patients that we would not be paid for the last 3 months ...
    I guess what goes around comes around ...

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