Here is a challenge for you. Approach several of each of these categories and ask them what primary care is:
- Outpatient internists
- Inpatient internists
- Family physicians
- Nurse practitioners
- Medical subspecialists
- Surgeons
- Patients
- Health administrators
- Insurance companies
- Emergency physicians
I submit that you will hear very different answers. We put great energy into discussions of our primary care shortage, but semantics make this discussion confusing.
Read this wonderful article about Rich Baron – Delivering Better Primary Care
Rich provides high quality comprehensive care of complex patients.
Dr. Baron’s more recent paper in the health care policy journal Health Affairs describes how his practice has attempted to move away from the traditional fee-for-service care model to a more comprehensive one that is centered on the patient and preventive care. As part of a three-year statewide and multipayer-financed initiative that compensates providers for not only office visits but also prevention and disease management, Dr. Baron’s group has developed a program that encourages continuing dialogue between providers and patients with diabetes, high blood pressure and elevated cholesterol, patients who make up nearly three-quarters of the group’s practice. Patients meet with trained medical assistants and create a set of self-management goals that become part of their electronic medical record, then share the results of their efforts with the medical team on an interactive Web site and during follow-up calls.
Rich has developed a patient centered medical home. Is that primary care or that something more?
I believe that what Rich and his group do strongly resembles my recent call for Consultant Internal Medicine. What he does differs greatly from the dictionary.com definition of primary care – The medical care a patient receives upon first contact with the health care system, before referral elsewhere within the system. (American Heritage Dictionary)
We (the internal medicine community) have an obligation to better define what we do. I believe that most of my outpatient colleagues are closer to Dr. Baron’s model than the American Heritage primary care definition.
But can Dr. Baron’s model work given our payment model:
Q. How can we help more patient-centered and collaborative models flourish?
A. We are in a kind of Gordian knot right now. We have models for creating new devices or drugs: pharmaceutical or biotech companies create partnerships with academia. Someone says we are going to create a laboratory, shelter you, then figure out how to bring your product to the market. When devices or drugs get developed in this way, it is not under market conditions.
But we have not had the same situation in primary care. We haven’t had a protected laboratory for people to innovate around service delivery and to try to figure out how we can do better. There are huge opportunities to do our work more effectively and consistently, but we haven’t had the same kind of support.
In fact, I’m not sure we will be able to continue the new program in our practice if we cannot get resources to support us beyond the three-year commitment.
