“There is no issue today more important to CEOs than workforce and that is at least as true in health care as any other industry.” Primary care is especially impacted by these stresses. I have kept in touch with a number of my primary care colleagues, and many are looking for something else to do. They are very dissatisfied. Most of them are employed by big health systems and they are just a cog in a wheel. They are not paid on the basis of the quality of their care. Payers pay for a visit note under our fee-for-service system. So the more visit notes a primary care provider generates, the more the system gets paid. In turn, the system pays the physician for the number of notes she generates. They are on a hamster wheel, governed by they tyranny of the urgent. It has all been amplified by the pandemic.
While I agree with the linked article, it does not begin to go far enough. This crisis will not be solved by tweaks and bandaids. The top three diagnoses leading to adult primary care outpatient visits are hypertension, high cholesterol, and diabetes. Five of the top ten diagnosis are cardiometabolic. These are all priority chronic conditons that lead to most premature death, disability, and cost. Twenty years ago the National Academy of Medicine called for extensive reengineering of the care of chronic conditions like this. “The American health care delivery system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive.” Until we dramatically change care delivery, primary care providers will continue to be dissatisfied and we will not have patient-centered care.
Nurse practitioners do exceptional work with each of these cardiometabolic priority conditions. In fact, teams of nurse practitioners and pharmacists are the only care delivery model that works consistently to improve care of these chronic diseases. “The one approach that has proven to be effective is using specially trained nurses or pharmacists, under appropriate supervision, with authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms.” Optimal medical therapy makes those teams even more effective. The evidence is crystal clear. It is time to stop talking and to begin reengineering the system.
I’ve seen the amount of time with a doctor shrink to barely 10 minutes. You present the answers here, but when will our health care systems change?
Yup. We need fundamental reform or the legacy American Medicine as a “profession” will be done with: https://www.linkedin.com/posts/joseph-thomas-shen-md-b01760106_culture-physician-doctors-activity-6925804881869987840-5zgZ?utm_source=linkedin_share&utm_medium=ios_app