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!

An interesting article from Health Leaders Magazine Online poses the question: could specialists be retained to fill gaps in primary care? The article proposes that we could ease the burden of the primary care shortage by retraining specialists to fill gaps in primary care. They argue that reforms targeting the primary care pipeline will take several years to take effect, thus there would be a quick turnaround with specialists since many already have a foundation in primary care. Here's an excerpt:

Joe Paduda argues that it would be far "easier, faster, and cheaper" to retrain specialists than to increase primary care training from the ground up. Specialists already have the medical background and could be easily trained to practice primary care with a specialist tilt. Cardiologists, for instance, could take a more active role in follow-up care and overall coordination before and after a patient undergoes a major heart procedure.

However, as the article also points out, taking on more preventative services and care coordination is only worthwhile for specialists if the change were to increase their profits, which in my opinion, completely defeats the purpose. The end goal we're working toward is to increase the availability of primary care services for Americans and increase health quality outcomes and value-- objectives that have historically been linked to primary care not speciality care.

Do you think an initiative to retrain specialists in primary care would lead to increased access to much needed primary care services and still lead to higher quality and value outcomes?

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