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American Health Care Depends on Rebuilding and Mobilizing Full Primary Care Team
Last week was National Primary Care Week and Primary Care Progress (PCP)’s co-founder and president calls all members of the primary care community to come together as a team both to deliver primary care and to advocate for it.
Last week was 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 U.S. 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, which 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 a 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 U.S. 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.
We hope National Primary Care Week kicks 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, M.D., is an internal medicine physician and president and co-founder of Primary Care Progress.
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