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Putting Joy Into Practice: A Journey Into Primary Care

Dr. Christine Sinsky is on a mission to improve the work-life of primary care physicians and clinicians to improve care and attract physicians to primary care.

A member of the Board of Directors of the American Board of Internal Medicine, Dr. Sinsky is a board certified internist who practices internal medicine at Medical Associates Clinic and Health Plans in Dubuque, Iowa, a level-3 Patient-Centered Medical Home since 2008. She is deeply committed to solving the ills of primary care and has a clear vision of what should be happening in primary care practices in this country.

Dr. Sinsky and her colleagues visited 23 high-functioning primary care practices and came away with some interesting findings. As the work of a primary care physician is now constructed, too much of their time is being spent performing functions that do not require professional training. Yet at these high-functioning practices, Dr. Sinsky et al. noted several innovations that had been put into place which resulted in replacing clinician burnout and patient dissatisfaction with joy of practice, improved patient care and a better patient experience. What did these practices have that others didn’t?

The findings Dr. Sinsky and her colleagues uncovered included innovations that freed physicians and clinicians from administrative duties and better organized their work. They removed things that didn’t add value to their patients and put clinicians more in control of their work environment. Such innovations included:

  • pre-visit planning;
  • improved team communication through co-location;
  •  in-visit scribing for medical record documentation;
  • expanding health care coaching, care coordination and integrated behavioral health to non-physician members of the team and
  • re-engineering prescription renewals.

Dr. Sinsky et al.’s findings will be presented to invitation-only conference sponsored by the ABIM Foundation to a group of influential health care leaders on March 12. Attendees will be charged with spreading these innovations among the primary care workforce.

As I prepare for the March 12 meeting, I can’t help wondering what led these practices to improve primary care and make vital investments in support of the Triple Aim (population health, quality and reduced costs)? I have some ideas and they vary largely due to the context of their practices:

1)  Leaders within these practices had the vision to realize that by improving the work of their primary care physicians, they improved the quality of their lives, which in turn produced higher quality patient care.

2)  Much of the practices’ financial success is linked to strong, functioning primary care.

3)  Some of these practices understand that the future state of health care will have primary care at its core.

4) Some of these practices are in rural areas where efficient use of primary care is essential to the well-being of those served.

5) Last, but not least, is that the concept of the patient-centered medical home is taking hold and appropriate incentives are being put in place.

I look forward to discussions on the “whys” of these innovations as well as the “what” with Dr. Sinsky and the 20 or so practice innovators whom I consider heroes of primary care.

5 Comments to Putting Joy Into Practice: A Journey Into Primary Care

  • Virginia Tilden's Gravatar Virginia Tilden
    March 13, 2012 at 9:12 pm | Permalink

    Daniel — great blog, as always. One comment about your second point in the list of reasons that these practices embarked on their innovations — the point about financial success due to strong primary care. I suggest that financial success – or at least financial equilibrium — comes from taking full advantage of an interprofessional team. By spreading the work around appropriately, effectively, and efficiently, a practice can see more patients and thereby generate more revenue. Even more importantly, team-based care has been shown to improve patient outcomes. This is important not only because it is better for patients but also because payment may eventually shift from volume to outcome.

  • Marc S Frager's Gravatar Marc S Frager
    March 9, 2012 at 1:31 pm | Permalink

    When payers desire accountability is it professional for the physician to please the payer if it is not necessarily in the best interest of the patient?

  • Marc S Frager's Gravatar Marc S Frager
    March 9, 2012 at 1:23 pm | Permalink

    Thank you Dr. Wolfson. I have noticed several direct pay plans, for instance Qliance, which are very reasonable. Qliance lists their charges at $99/month/family which is less than my monthly cell phone bill. This method reduces bureaucratic overhead and directly aligns physician interests with the patient rather than the government or insurance company.

  • Marc S Frager's Gravatar Marc S Frager
    March 9, 2012 at 7:46 am | Permalink

    I believe another way to put joy into practice for primary care physicians is the direct pay approach. It seems that there could not be a more ethical or professional way to practice medicine then when the physician and patient agree to terms free of government interference. This allows the physician to work directly for the patient rather than the insurance company or the government. Joy comes from this approach and from the absence of bureaucratic requirements and hassles. Direct pay seems to be increasing in frequency as large numbers of patients and physicians become frustrated with government and insurance regulations and constraints.

  1. By on March 19, 2012 at 2:17 pm

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