Re: IMP model and primary care shortage

[Guest guest]

Is resistence futile?

Is demonstration of "quality for IMPs" enough to convince powers that be to let ME practice in a "non-clinic" environment?

With current proposal as stands (1-3% of Medicare "bonus to be paid AFTER THE FACT) can any solo/SG even AFFORD to "do this experiment."

I'm more and more "having to say NO" to these "unfunded initiatives" like PQRI and "formal EMR" (I use SOAPware not in CCHIT format) and ePrescribing (not cost effective) although I use appointmentquest.com, do same day/next day appointments, 24/7 availability, secure email (relayhealth meesaging only).

Show me the money............

Matt Levin, MD

Solo FP western Pa x 4+ years

20 years practice

IMP model and primary care shortage

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