IMP model and primary care shortage

[Guest guest]

Carla raised this issue in her recent post.

This comes up when I talk to reporters and health policy folks and is a

legitimate concern, so I wanted to post my response.

The primary care shortage is due to the

generally miserable lot of primary care practice in the US. A

recent study of why fourth year medical students shy away (in droves) from

primary care points out that they perceive the impossibility of doing a good

job given the pressure on primary care and say (logically) “No thanks.”

To address this problem we need to present

primary care as a field where one can be professionally satisfied and adequately

remunerated while having a reasonable balance between work and life. None

of these things are supported in the current paradigm of inadequate funding,

quantity-over-quality, and the crushing burden of administrative trivia brought

to bear by an insurance industry run amok.

Hypothesis: team-based care with

non-physician work delegated to non-physicians, large patient panels and high

flow (visits per hour plus phone & email care) can be done very well and

achieve excellent outcomes. This is possible. Let those who would

try this work be funded to experiment and show the results.

Is this the model of practice we should all

adopt?

Unlikely. Some don’t like to practice

in this practice model and some patients don’t care to be served in this

practice model.

Hypothesis: micropractices with low

flow can achieve excellent outcomes.

Our data look pretty good so far, so this

appears possible as well.

Is this the model of practice we should

all adopt?

Unlikely. Some don’t like to practice

in this model and maybe some patients prefer the big shops.

Neither is adequately funded and both are

crushed by the administrative trivia, but both ends of the spectrum are

possible. Let’s keep the door open to both so that there are many

potentially successful models around. The real solution to the primary

care shortage is not to force one model or the other but to create an

environment truly supportive of excellent primary care.

There are articles in the pipeline from

the work of others (non-IMPs but very good people) demonstrating that the most

powerful way to keep PCPs in the work force is to cut back on panel size and

adequately support the work. With (absolutely drop dead essential) change

to the way the money flows this problem can be solved. Until then I

applaud any PCP in the country who can hang on to even a little bit of their

professional identity in the face of this relentless onslaught. Half a

panel is better than none.

Gordon