A Trip Down Family Medicine Lane

2016-11-12-20-00-45

Kalaki M.Clarke, MD

The health care road has been less than smooth on the family physician’s journey towards optimizing America’s health. Nevertheless, I’m optimistically looking down that road and believe that 10 years from now, many of the present potholes will be filled in and many flashing red traffic lights will be repaired.

One of the main potholes in the health care road that I foresee being repaired is the family physician deficit. Currently, one-third of physicians provide primary care while more than half of all clinical visits are in primary care offices. Clearly, this particular dip in the road begs reconstruction. How do we fix this? Repair begins when family physicians fully take full pride in our responsibilities as the cornerstone of American health. Our demonstrated passion as comprehensive care providers for patients from the womb to the tomb will draw the next generation of physicians to family medicine as their vehicle of societal contribution. Medical students will inevitably be compelled to join us for the ride and contrary to popular impression they’ll discover that we see more in our clinics than the self-limited rhinovirus. They will then be less lured by the fancy and shiny specialty-driven vehicles currently advertised as the sole solution to professional fulfillment.

As our workforce increases, down the road the disproportionate 2:1 specialist to primary care provider ratio will reciprocate. We are actually headed in the right direction evidenced by NRMP (National Residency Match Program) stats showing that 95% of family medicine training positions were filled in 2016 compared to 85% in 2006.

What about some of those flashing red traffic lights presently stalling our journey’s advancement? One of the largest of these is the one that fails to value the practice of primary care. An associated roadblock includes the imbalanced manner in which family physicians are financially compensated. On my recent sports medicine rotation I was taken aback when my attending shared with me that the encounter time we spent as consultants would have been reimbursed triple the amount had we served as primary care providers managing multiple chronic conditions.

Although that was a disturbing realization, I was filled with renewed appreciation for family medicine when I learned from the AAFP Immediate Past President, Wanda Filer, MD, that the death rate decreases in communities with family physicians. Intrigued, I investigated further and found literature that cited National Institute of Health (NIH) studies published in the 1990s which proved that US states with higher ratios of PCP to population had better health outcomes including lower rates of all cause mortality from heart disease, cancer, and stroke. All of these outcomes were independent of the highly relevant social determinants of health. If that information doesn’t scream “high value” with the potential to achieve the Triple Aim (and even the Quadruple Aim), please tell me what does.

Ten years down the road our efforts to increase our patient’s health literacy through education and preventative care promotion will be encouraged. We will also be measured on outcomes such as the percentages of hospitalization reduction and chronic disease control instead of how many clicks we’ve made in the electronic health record. As primary care’s value is fully appreciated, we will be compensated at the level of our specialty colleagues for keeping patients well. Ultimately, the kinks currently present in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that I admittedly do not understand, will be straightened out. Family physicians will be recognized and respected as leaders of value based, patient-centered care. We’ll move from the back seat of the health care vehicle and take our rightful position as the drivers of American health. Even jaded family physicians will be inspired to get out of the trunk and join us on the inside! We’ll also catch up with other first world countries located many miles ahead of us that have already figured out how an efficient health care system should operate.

In our travels along the health care road, the song “Teamwork” should be programmed to replay through our vehicle’s speakers. A non-hierarchical demonstration of respect towards our Allied Health support in a collaborative approach to patient care is an essential shock absorber for a smoother ride. I often tell others that as a family physician I am a “jack of all trades and a master of none”; I can remove my patient’s ingrown toenail without referring them to podiatry while acknowledging that writing dialysis orders are not part of my skill set. Although we drive this vehicle, there are times when we must appreciate the specialist’s hand to help steer us in clinical decision making. In some cases, we even have to allow our colleagues to temporarily take the wheel. When we consistently choose to carpool in our patient care efforts, we ensure that no one runs out of gas.

As we safely remain in our vehicle and continue our journey, the health care road will become smoother and our path will be unencumbered as the light eventually turns green. May we never lose our momentum because soon, the voice of our GPS (Great Public Service) as family physicians will announce to each of us, “You have arrived at your destination.”

References
  1. National Ambulatory Medical Care Survey:2012 Summary Tables, Table 1
  2. Starfield, B., Shi L.,Macinko, J.Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly. 2005 Sep; 83(3):457-502.

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