Assessing the Current Primary Care Situation, I Choose Hope Over Despair

Carlos Roberto Jaén MD, PhD

According to Merriam Webster’s dictionary, tipping point is “the critical point in a situation, process, or system beyond which a significant and often unstoppable effect or change takes place.” It’s not when the change is fully apparent, it is when it starts irreversibly. As the Affordable Care Act and 2014 loom in the horizon, some of our academic colleagues in the ROAD specialties are describing the local professional scene as one of “suffering” for their colleagues (“They’re losing their shirts”), probably an exaggeration but nevertheless a change. Many of their graduates, after years of “investment” in their training, will be disappointed.

We must remain steely in our resolve to build residencies and undergraduate programs that teach the fundamentals of the new order: team communication, team building, population health, whole person/whole population care—at whatever cost is necessary and possible. We must do the right thing for our patients and the populations we serve. Yes, we must do this in the middle of a rigged system that undervalues, despite all the rhetoric, what we do in primary care. We must educate our colleagues to the reality that primary care is so much more than wRVUs and “feeder” programs. They must lean that primary care is “taking care of folks,” over time, with commitment. It is about populations and lives we care for, not about more procedures and visits only. We are not ambulatory care like radiology and/or ambulatory surgery are ambulatory care.

Primary care is about embracing complexity with gusto. Yes, we are the experts in complexity because we deal with complexity in context. We cannot afford to wait for the payment fix to be in place to act. By then it will be too late. We must cobble our road with the fundamentals so that when 25-year-old medical students wake up, and they will wake up, they will have a road that leads them to take over for us before our rocking chairs arrive. We must keep in mind what our Advanced Primary Care Team recently discovered, the currency of primary care—of family medicine—is “Atención y respeto” (attention and respect). That is what our patients deserve, that is what our communities expect, and that is the foundation on which our next generation will build the next iteration of what we offer today.

A hopeful fool in San Antonio,
Carlos