Health Care Expert Calls for Revitalization of Primary Care

The traditional model of primary health care is no longer sustainable, requiring a revitalization that entails fundamental changes in how primary care is delivered and financed. That was one of the primary messages delivered by AAFP member Kevin Grumbach, M.D., professor and chair of the Department of Family and Community Medicine at the University of California, San Francisco. Grumbach spoke during a primary care forum convened by the AAFP's Robert Graham Center here on Jan. 29.

He said the traditional model of primary care has not been very well supported by payers, purchasers or government agencies, so people are turning away from it.

"When we talk about how we can revitalize primary care, there is a sense of how Congress and the new administration can come together and make some differences," said Grumbach, who is chief of family and community medicine at San Francisco General Hospital. But he also called on primary care health professionals to take ownership of the field to reinvent primary care and design new models of care for the 21st century.

"This model of 19th-century practice -- of the doctor in the office and patients coming in -- is not going to work in the 21st century," said Grumbach. "We have come to the proverbial fork in the road."

Grumbach identified physician payment reform as one of the first steps in revitalizing primary care.

"(Sub)specialists have done awfully well in the current environment, and there is going to have to be some rebalancing," he said. However, he added, "I don't think specialists are going to take to that voluntarily, and I think there is going to have to be some reckoning."

Grumbach noted that health information technology, or HIT, is one way to invest in the nation's primary care infrastructure. However, he added, "we need to learn how to employ these (systems) effectively."

"It is not enough to come up with the right software and the right hardware," Grumbach said. "People need help … to incorporate this is in a way that works in the medical home."

HIT should be used to create patient care registries, reminder systems and patient portals so patients can access their test results, said Grumbach. There is a risk of spending billions on HIT and then allowing the systems to simply sit there. "(HIT investment) has to be coupled with a strategy, and some of that money needs to go into technical support," he said.

Health care systems based on primary care achieve better health care outcomes and a higher quality of care, said Grumbach, adding that the primary care infrastructure in the United States is crumbling, however. Very few new physicians are choosing primary care as a profession, largely because of the substantial income disparities between primary care physicians and subspecialists, he said.

The ongoing shortages of primary care physicians are fueling "medical homelessness," leaving patients without adequate access to primary care services and patient-centered medical homes, Grumbach said. Without a greater investment in the primary care pipeline, the shortages will continue to grow. As a result, the government could end up enacting national health care reform without really enhancing access to care or improving health care services, he warned.