NEJM - The Need for Reinvention [Re: Primary Care]

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http://content.nejm.org/cgi/content/full/359/20/2085

Summary:

The editors asked several experts to share their perspectives on the crisis in U.S. primary care. Their articles, which address this crisis from six different angles, follow. We also brought the five U.S. contributors together for a roundtable discussion of the problems and potential solutions for training, practice, compensation, and systemic change. A video of the discussion and reader comments can be seen at http://www.nejm.org.

You can download a PDF of the entire article here.*

A transcript of the video, also in PDF format, is located here.

*Edit: My download only contained the first two pages of the article. I think something's broken on the NEJM site.

 

[Red Beard]

From "Lessons from the U.K." (same issue of NEJM):

The United Kingdom takes the importance of primary care for granted. The U.K. government is effectively the country's single payer, and successive administrations have been convinced by mounting evidence that primary care promotes high-quality, cost-effective, and equitable health care.1 If anything, the U.K. government has become more convinced over the past 15 years that strong primary care needs to be at the heart of the country's health care system — quite the reverse of the situation in the United States. U.K. primary care physicians now have average earnings of $220,000 (in U.S. dollars), which is more than many specialists earn. The payment system is a mixture of risk-adjusted capitation and 25% additional pay for performance.

 

[andwhat]

From "Lessons from the U.K." (same issue of NEJM):

It is simply ridiculous, just talk talk talk about a "Primary Care shortage" but NO actions.
Increase the pay, and that will solve almost all of the problems.
That will help make the transition to "this is what I was meant to do"
Talk talk talk talk, that is all that is done, and no actions......
There has to be solutions at some point, instead of just focusing on problems. Disappointing.
Interesting article, hopefully medicine catches up here one day.

 

[Joe Richards]

It is simply ridiculous, just talk talk talk about a "Primary Care shortage" but NO actions.
Increase the pay, and that will solve almost all of the problems.
That will help make the transition to "this is what I was meant to do"
Talk talk talk talk, that is all that is done, and no actions......
There has to be solutions at some point, instead of just focusing on problems. Disappointing.
Interesting article, hopefully medicine catches up here one day.

Be patient. (but not too patient)

These discussions that are taking place NOW did not take place like this before.

There are some great ideas on the table and they will change the way primary care is practiced in the USA.

I don't agree with some of the quality and outcome ideas because they are difficult to measure and there is too much variance. However, the rest of it is right on.

Our medical system is ready for this. The AAFP has been pounding the legislatures to accept the Medical Home model. They are buying into this idea. The payment changes go along with that.

I'm not even a huge proponent of the medical home model but if it gets us to higher pay, I say lets do it.

I believe that in the future most primary care practice will be set up with several doctors. This will lower the burden of the sole practitioner to set up a medical home model.

There will be Nurse managers who will be responsible for following outcomes and helping increase better outcomes and therefore pay.

To fix the shortage problem you need to fix the pay issue AND the way medicine currently looks at primary care.

 

[andwhat]

Be patient. (but not too patient)

These discussions that are taking place NOW did not take place like this before.

There are some great ideas on the table and they will change the way primary care is practiced in the USA.

I don't agree with some of the quality and outcome ideas because they are difficult to measure and there is too much variance. However, the rest of it is right on.

Our medical system is ready for this. The AAFP has been pounding the legislatures to accept the Medical Home model. They are buying into this idea. The payment changes go along with that.

I'm not even a huge proponent of the medical home model but if it gets us to higher pay, I say lets do it.

I believe that in the future most primary care practice will be set up with several doctors. This will lower the burden of the sole practitioner to set up a medical home model.

There will be Nurse managers who will be responsible for following outcomes and helping increase better outcomes and therefore pay.

To fix the shortage problem you need to fix the pay issue AND the way medicine currently looks at primary care.

agreed.. hopefully these 'changes' happen soon....
nothing but talk thus far, and no changes whatsoever. As a matter of fact, I have seen things go the opposite direction, with decreased funding to Community Health Care centers.