Primary concerns

Mary Stevens, editor, CMIO

Recent surveys and research offered several items of interest for primary care physicians. For starters, Match Day last week saw 11 percent more U.S. applicants matched to family medicine residencies than in 2010, the National Resident Matching Program (NRMP) disclosed.

Among primary care specialties, family medicine programs enjoyed the strongest growth in the number of positions filled by medical school seniors from the U.S., according to the NRMP. Although the numbers represent an uptick, not an explosion, they are still encouraging.

These generalists will be at the heart of new care models, such as patient-centered medical homes (PCMHs) and accountable care organizations (ACOs). In addition, primary care specialties are the fields of choice of many eventual CMIOs.

There will certainly be room for new primary care practitioners if the Patient Protection & Affordable Care Act stays the course: an HSC study predicted Medicaid eligibility will expand to cover as many as 16 million more low-income adults by 2019. Primary care capacity may not be adequate to meet increased demands from these new Medicaid patients, according to the HSC: “Combining payment reforms with delivery system reforms will ultimately be essential to meet the long-term challenges of increased demand and limited supply.”

The demand for primary care physicians may be rising, but a report released this week says 2010 was a year of dissatisfaction for many in the field. Forty percent of the physicians surveyed in medical market researcher M3 USA’s annual poll of primary care physicians considered leaving their profession last year. More than 16 percent reportedly contemplated this for the first time in 2010. M3 USA opined that the business pressures of running a small practice, the “avalanche of paperwork” and physicians’ lack of time with patients might be some of the reasons for this level of dissatisfaction.

Unfortunately, analysis of new care delivery systems was also sobering this week. For example, researchers reported in Health Affairs that the transition from general practice to PCMH can take three to five years to complete and physicians will have to develop and use team-building skills, as well as some expertise with computer systems.

A separate study in the New England Journal of Medicine indicated that ACOs, as currently envisioned, could lose money for five years before the organization recoups even some of its original investment—even in practices with robust IT infrastructures and solid financial footing.

Do you see primary uncertainty ahead? Let me know at mstevens@trimedmedia.com. 

Mary Stevens
Editor of CMIO