Bodenheimer T, Berenson RA, Rudolf P. The Primary Care-Specialty Income Gap: Why It Matters. Ann Intern Med. 2007;146(4):301-306.[Accessed March 27, 2008].
Sepulveda M, Bodenheimer T, Grundy P. Primary Care: Can It Solve Employers’ Health Care Dilemma? Health Aff. 2008;27(1):151-158. [Accessed March 27, 2008].
Where I am living and working, primary care is receiving a lot more attention – more than I have ever experienced it getting. That could be because I have been living and working in a place (Seattle) where primary care and family practice is well understood and now I am in a place where maybe it is not understood as well (Washington, DC), or there could be a change in conversation happening nationally. I think it’s a little of both.
I recently read the attached articles – there are many more from these distinguished authors, and for every article, many many blog posts covering the topic of primary care survival.
The articles, for me, highlight the idea that from a societal perspective, primary care helps people achieve their life goals through optimal health. The societal part means that this is good for people, their families, their employers and their communities. Paul Grundy, MD, in particular is raising awareness of the role of employers in supporting a balanced care system.
The articles also highlight that not everyone is taking a societal perspective in the discussion. From the Bodenheimer article:
It’s unclear whether the medical profession – with different specialties having distinct monetary interests and different estimations of the professional value of their work – can agree on substantial changes in payment policy on its own
This strikes me as a wise statement to make based on current conditions. At the same time, in the work I have done to help transform a health care system using LEAN (Toyota Management System), I have learned that this condition can change, and physicians can come together, if the view we take is one about the patient (which is really one about society).
When I walk into a room in my health informatics role, I feel that I am representing myself as a physician, rather than as a family physician. This helps me be aware of the contributions my specialty colleagues make to improving primary care and the skills of the people who deliver it. Their contributions are significant. Because of this experience and my experience practicing the Toyota Management System, I have an interest in the inclusion of all physicians (and all patients) in this discussion. I am wary of writing that implicitly or explictly states that the tension should be or is between primary care and specialty care. I think our patients and our society are wary of that idea, too.
I’ll end my comments there and welcome others’ ideas.