Longer days, lower pay, less prestige and more administrative headaches have turned doctors away in droves from family medicine, which has traditionally been the frontline for wellness and preventive-care programs that can help reduce health care costs.
In fact, according to the American Academy of Family Physicians (AAFP), the number of U.S. medical school students going into primary care has dropped 51.8% since 1997.
There are about 65 million Americans living in communities where there is a shortage of primary care physicians (PCPs). Add to this unmet demand the fact that an estimated 34 million people will soon become insured, as a result of the healthcare reform, further increasing demand for primary care services.
Why is it important to address the issue of primary care? States with a higher per-capita ratio of primary care doctors have lower mortality rates from health conditions such as cancer, stroke and heart disease.
One proposed method to help alleviate the PCP shortage is through an Accountable Care Organization (ACO). ACOs are provider groups that accept responsibility for the cost and quality of care delivered to a specific population of patients cared for by the groups’ clinicians . Accountable care organizations will be largely based on physician practices that may be organized as patient-centered medical homes.
Some key features of patient-centered medical homes are:
• Patients’ care is team based, preventive and comprehensive vs. one-on-one, fee-for-service or managed.
• Record keeping and sharing is electronic vs. paper based.
• Clinicians from the team are accessible via the internet, phone or in-person vs. through an answering service or even unreachable due to heavy patient schedule.
There are a number of clinics in the U.S. that have adopted the philosophy behind patient-centered medical homes. Martin’s Point Health Care in Maine and New Hampshire, Greenfield Health in Portland, Oregon and Laguna Beach Community Clinic, Laguna Beach, California are a few that have implemented this model of care.
So far it has worked for Dr. Doug Couper of Martin’s Point. “I can get here and back home during daylight hours on a bicycle,” he says. No more 12-hour days for this primary care doctor. He points out that he’s able to keep his practice efficient by utilizing his whole team – for example, he confers with his nurse about patients, uses his staff for scheduling, and uses electronic medical records to check patients’ progress. Dr. Couper is able to quickly pull up data on his patients and can see, for example, which patients’ blood pressure is under control and which patients are in need of follow-up.
At Greenfield Health, doctors often do not see patients for things such as test result interpretation or medication adjustment says Chief Operating Officer Steve Rallison. Instead, it is done via phone calls 35% of the time, and secure messaging, 40% of the time. One patient of Greenfield says, “If I have questions…I just slip out my iPhone and type out an email to him. Lo and behold I might get an answer back in 20 minutes.”
Laguna Beach Community Clinic uses full-time family physicians and brings in volunteer specialists that take a comprehensive view of health care. “We really focus on the whole person that way,” says Dr. Tom Bent, Medical Director of the Clinic. “The result is more efficient than other alternatives, and far less costly than unnecessary emergency room visits. You save money and improve quality.”
The healthcare reform bill provides an additional $11 billion in funding for community health centers, many of whom operate as patient-centered medical homes. These healthcare centers now serve more than 20 million people nation wide. The overall effect of increased health center funding is estimated to generate at least $180 billion in systemwide health care savings by 2019.
Patient-centered medical homes can and have worked at improving practice efficiency, patient care and lowering costs. However, in order for this model to succeed, according to Dr. Terry McGeeney, a primary care doctor and Chief Executive of TransforMED , “practices do need support, providers need to want to provide this kind of care, payers need to pay for this kind of care, and patients need to demand and expect this kind of care.”
We’re interested in hearing your thoughts on patient-centered medical homes and its effect on the future of primary care.
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It is true that there is a recent decline in this “frontline” however, there is a strong connection between the evaporation of the middle class and the motivation for medical students to get into that particular path. I cannot speculate what is to come from this, however, if the trend continues, the obvious is a negative outcome.
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