The list of problems with primary care today is long and long-standing. Patients are frustrated and confused. Providers feel pressure to see more patients even as their reimbursements go down. Medical schools push students toward hospital-based sub-specialties. And for those who choose primary care, the training neglects important new skills, such as working in a team and engaging patients in their own care.
All this as the nation prepares for a spike in demand for primary care providers – fueled by millions of patients newly-insured through the Affordable Care Act – and a drop in supply due to retirements in the aging physician workforce and the unpopularity of the specialty, according to four panelists at Health Journalism 2013.
“I hate to be a downer,” said Andrew Morris-Singer, M.D., president and principal founder of Primary Care Progress. “We do have profound problems in the primary care pipeline.”
Solving the problem boils down to making essential changes to the way primary care providers do business, the panelists agreed.
These practices of the future – some of which already are operating – emphasize engaging patients, using technology, and distributing patient care across a primary care team.
Jane Maffie-Lee, a nurse practitioner, is the clinical program director at the Ambulatory Practice of the Future at Massachusetts General Hospital. The program treats hospital employees and is meant to reduce costs while increasing the satisfaction of patients and providers.
Features of the practice include sharing patients’ medical records with them, and maintaining a team environment where everyone from front-desk clerks to health coaches run staff meetings.
“It’s important for us to have a culture of collaboration with our patients,” Maffie-Lee said.
G. Alan Kurose, M.D.,’s Rhode Island practice, Coastal Medical Inc., operates under similar principles. A provider is available to patients every day of the year, and the practice uses its data to analyze costs of care through comparisons of insurance claims and clinical information.
For the new approach to work, future primary care doctors need to master skills not previously associated with medical training.
Morris-Singer started his national nonprofit, Primary Care Progress, to promote the curriculum changes and to spotlight innovations.
Harvard Medical School started focusing on such changes about two years ago, with its new center for primary care.
Primary care doctors of tomorrow need to be excellent clinicians, but also to be effective communicators and leaders who know how organizations work and how to work on a team, said Andrew Ellner, M.D., M.Sc., a co-director of the Harvard Center for Primary Care and a practicing internist at Brigham and Women’s Hospital.
“For us to succeed in health care reform, the transition is really from a system that’s built completely around doctors to ideally a system that’s built around people – I would even say patients,” Ellner said. “And that’s a pretty dramatic and profound, not just system transformation, but cultural transformation.”