Both current Senate and House bills include legislation aimed at increasing the number of primary care physicians in America by increasing funding to medical institutions to increase the number of primary care residency slots. However in 2009, 9% of primary care residency slots went unfilled in comparison to 1% rate for residency slots in anesthesiology, which often offer more regular working hours and almost twice the salary.  So, will throwing more money at primary care residency programs increase the number primary care physicians? Probably not, since it appears that the primary care problem is rooted in life post GME. We've found from speaking to primary care practitioners as well as through our own research, that the primary care shortage is driven by a number of factors:

• Rapid rise in medical education debt
• Misaligned payment incentives that lead to poor pay and long working hours
• Increased burdens associated with the field.

Additionally, mismatches in supply (e.g., length of postgraduate training, compensation gap, desire for a more ‘controllable lifestyle’) and demand (e.g., total and aging population growth, chronic condition prevalence) are becoming deep-seated drivers of the shortage that require urgent action outside the scope of legislation. Thus, Hope Street Group is currently investigating ways to reinvent the primary care business model to make the field more attractive and equitable to primary care practitioners. We would love to hear from all of you about unconventional primary care practices that have implemented innovative and effective changes to optimize their business models. Post your comments by Logging in or registering!

The Techie site, Ars Technica (that’s “the art of technology” for you fellow latin buffs) recently published an article about bringing telemedicine to the ICU with mixed results on their site.  I found this super interesting, as telemedicine is a practice getting more traction given the primary care shortage. For those of you unfamiliar with telemedicine, it is a lot like it sounds- physicians use the phone or the internet (mostly) to provide clinical care to patients and/or consult with other physicians. It also includes the use of satellite and video-conferencing equipment to conduct real-time consultations between medical specialists in different locations.

Telemedicine is particularly interesting to me within the context of primary care, however Ars Technica approached the topic in terms of intensive care medicine,

“At first glance, an ICU might not be the obvious choice for telemedicine, given its focus on intensive care, which implies lots of hands-on intervention for a wide range of ailments. But a large portion of the work involved in an ICU is a matter of monitoring patients for changes, which doesn't necessarily require direct intervention. And, in other ways, the ICU is a perfect fit for telemedicine. Training dedicated intensivists as a separate specialty has a limited history in the US, and there remains a critical shortage of these doctors. Meanwhile, studies indicate that dedicated intensivists provide improved outcomes to ICU patients. Telemedicine could potentially allow these limited specialists to monitor more patients (as well as patients who might not otherwise have access to them), making up for this shortage."

The article references a study released by the Journal of the American Medical Association that suggests that telemedicine may bring some small benefits with subtile impact to the ICU, however Telemedicine an interesting concept that deserves more thought and attention as we move forward in a reformed health care system and continue searching for new innovative ideas to enhance quality and reduces costs.

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