Hey #medtwitter #meded #primarycare

Declaration of Current Truths in American Primary Care

1/x?

We are dealing w many more early retirements

We are attracting far fewer students &residents to generalism &to longitudinal holistic care across age ranges

We are strained ->

2/

We are having a much harder time finding and recruiting primary care doctors to replace ones who’ve left

We are therefore all seeing more patients in a panel

We are therefore sometimes unable to physically see our continuity patients for all their needs

These needs ->

3/

.. are therefore met in urgent cares, ERs, and with APPs. Longitudinal primary care is fragmenting from within

There is no real discussion of panel size limits or complexity time adjustments during a session

Patients and their primary doctors are less happy …

->

4/

.. they can’t find each other

Patients are making this publicly known

The short term capitalistic microscope &scalpel is eroding primary care person power in the US

Remedies 2alter the path of these truths:

Make primary care more attractive

CMS &your w RVU scale->

5/

G2211 is NOT enough, stop giving in 2stagnant budget neutrality, & 2resident numbers from decades ago, &get out of the AMA wRVU consultancy, make your own decisions

If we insist on the wRVU to measure/monetize then start giving primary care enough credit to bolster it ->

6/

Employers/academic med centers:

It would help primary care, &there4 your communities &the health of the nation,if you would make primary care much more attractive

Drop wRVU/productivity terms/salary or metric increments at risk from contracts, pay us&get out of the way->

7/

Stop w non competes for other employers in region - you’re holding young MDs hostage who need flexibility 4family and $obligations if they want to leave

Primary care generates 2 hrs extravisit work 4each hr of patient facing time

We need standard team support->

8/

We need enough time for more complex patients, put this flexibility where it belongs, rid us of prescribed templates

We need enough time 4documentation while at work- this does not mean taking our eyes off the patient during visit

We need de commodification

Rehumanization

9/

UME/GME : primary care pipelines would be bolstered by med school - peds/IM/FM/geriatrics tracks that can offer tuition support - we lose some budding generalists to debt and opening salaries surpassed by all other career choices

If MD delivered primary care is to stay->

10/

.. it does so w intentional effort &innovative redesign immune from bottom line minded contracts, productivity penalties, generalism tax, prevention over tertiary tax, compressed commoditization and unkind unsafe workload expectations

We all deserve excellent primary care

Frank Cacace MD FACP ncbi.nlm.nih.gov/pmc/articles/P… Starfield Et Al describe the benefits of good primary care on health and health systems