National Primary Care Week 2012: What makes this year different?

It’s National Primary Care Week, an annual celebration when members of the primary care community come together across the country in events largely organized by trainees to celebrate, promote and advance primary care. So what makes this year different?

Put simply, the momentum for advancing primary care in the US has never been stronger. Those of us who believe that a robust foundation of primary care is essential to the health of individuals and society as a whole now face an unprecedented constellation of financial and political opportunities.

States such as Ohio, Oregon and Maryland are investing in their overall primary care infrastructure, and payers, such as Blue Cross Blue Shield, are boosting payments to primary care providers. They know that upfront investment will lead to improved overall health and lower costs in the long run. However, building upon this progress and turning our collective vision of a primary-care centered system into a reality will require us to do something that doesn’t always come naturally to health care professionals: work as a team, not only to deliver primary care but to advocate for it.

By “sharing the care” among a larger, more diverse group of health professionals with complementary skill sets, we provide comprehensive, front-line, patient-centered care that’s been shown to catch diseases earlier, better manage chronic conditions, and keep patients out of hospitals and away from crowded, costly emergency rooms. Payers, both public and private, are reasonably delighted by this new, patient-centered medical home model, that’s already being utilized by groups including Kaiser and Thedacare, who are increasingly investing in it to take advantage of its well-documented overall improvement in quality and costs.

Despite this model’s early promise and growing base of support, however, some challenges remain. Patient-centered medical homes only constitute small proportion of primary care practices across the country, and transforming a practice into this team-based model is no small feat. Additionally, most providers in the US still operate in markets that do not financially support this style of delivery. So building on early pilots’ success will require up-front investment from various payers. Then, teaching our colleagues how to transform their practices will depend on resources and support from various professional societies. Also critical for success will be increased engagement from patients, in their own care and in the redesign of practices to get them the care they want and need. Finally, all primary care disciplines will need to share and collaborate with one another as we’ve never done before – not only to quickly learn the most efficient and effective way to transform care delivery, but also to make the case to payers and patients alike for this new, team-based model.

But that’s not all. Experts unanimously agree that we don’t have the primary care workforce to populate team-based clinics. Our primary care pipeline has dried up after years of financial neglect, active discouragement of careers in primary care at medical schools, and misguided training strategies that have prioritized turning out highly sub-specialized practitioners at the expense of generalists. To stop this cycle, government funding of medical schools must incentivize updated primary care curricula and rebuilding the primary care workforce.  Pushing for this kind of change will require advocates of primary care to mobilize. The power to do this exists only when all primary care disciplines, namely family medicine, internal medicine and pediatrics, and all primary care professional networks, including but not limited to nurses, physician assistants and physicians, work together, and focus on our common interests as opposed to defending what we perceive to be our respective turfs.

It’s no wonder that numerous calls for this type of interdisciplinary, inter-professional and cross-generational partnership to advance primary care have echoed through our community recently, including a push for creating a new umbrella primary care organization. Without such a unified front, we’ll never be able to take on the fee-determining, specialty-dominated Relative Value Committee, the “RUC,” nor advance family medicine at one of the nine “orphan” medical schools that have shamefully excluded it from their curricula, nor motivate allied health professional training schools to update their curricula to prepare future grads for patient-centered primary care. All of these initiatives will require us to leverage the power and influence that we only possess if we break down our silos and come together.

So this National Primary Care Week, let’s kick off a spirit of collaboration and partnership among all members of the primary care community, not only to celebrate and promote the profound value of primary care, but also to collaboratively advocate for the financial support, educational reforms and renewed workforce that our collective primary care team needs in order to give Americans the high value care they deserve.

Andrew Morris-Singer is an internal medicine physician and President and Co-Founder of Primary Care Progress.

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  • ProudOkie

    Very thankful for primary care providers!! As a Family Nurse Practitioner, I look forward to establishing a small version of a PCMH in our NP owned clinic. We are looking forward to serving Medicare, Medicaid, and all other customers alike. Thankful for all PCPs!! This Primary Care Week, let’s come together as the author mentions and celebrate PCP diversity! great post!

  • buzzkillersmith

    Diagnosis: Correct. Treatment: Pie in the sky.
    Oh what a wonderful world it would be if PCPs were paid competitively, if we had jobs we actually could stand, and if we had any realistic hope of all of getting it together enough to work together with the subspecialists to take away a good chunk of their income.
    Oh what a wonderful world it would be if PCPs actually had the support they need to run a medical home, if someone else had to jockey those lousy EHRs, if we were not inundated by soul-crushing paperwork and administrivia, if medical homes would not burn out PCPs over a few years, and if those said medical homes were able to be developed everywhere, and if PCPs had control of those organizations, instead of having the organizations, either now or in the near future, controlled by businessmen and subspecialists.
    Oh, and I’ve worked for Kaiser–I had power of a Burger King worker and was bombarded by groupthink and a money-driven culture. That might be the answer for some patients, but its miserable for a lot of doctors. It would have been better to do something else.
    Look at the recent Burnout paper in Arch Inter. Med. and learn, Dr. Singer.
    I ain’t gonna be cheerleaded any more. We been screwed so badly for some long that those who still have hope are simply delusional. My goal is early retirement.
    Turn primary care over to the nurses (if they’re dumb enough to take it)and move on, young med students. There are better uses for your time.

    • Jonathan Coppin

      Sad. That’s fine if you’ve become cynical and have given up, you’re on your way out I guess. However, I don’t see why you would try to make things even worse by trying to discourage others, especially medical students, who still have a job to do and a role to play in patient care for the future. And speak for yourself when you say “if we had jobs we could actually stand.” Believe it or not, just because it’s hard work and there are things we want to change, many of us love primary care and wouldn’t trade it for anything. There will always be sick people, and if our country dissolves into a third world status and we are paid by our patients with vegetables to feed our families with, then at least we’ll be doing what we love. With that in mind, we can look to the future and how we might make our health system better for our patients, and move forward with those goals in mind. For those doctors who are burned out and ready to get out of the game I say fine, thank you for your service, but as you go please do not assume that everyone should now feel as you do, or ever will.

      • southerndoc1

        Primary care: lowest pay, highest burnout rate. They’re obviously doing something right!

  • Samir Qamar

    There is a lot of hope on the horizon with Direct Primary Care (DPC). DPC providers are not burning out, because they only hold half the national average of patient numbers in their practices. Payment is based on continuous membership, not on per-visit-reimbursements. DPC models decreases care overutilization and increases patient accountability with health care. Effective preventive medicine alongside basic primary care that is actually affordable? Medical insurance only being used for rare events, and not common, routine issues like allergies? No dependence on Medicare or private insurance reimbursements? This is the future of primary care. Our company, MedLion, is currently assisting doctors join the revolution. Because God know we need one.

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