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A Team Approach To Primary Care: Why Some Doctors May Resist

What if some physicians actually like the way primary care is currently practiced? It’s hard to believe, considering the majority of studies suggest marked dissatisfaction among primary care doctors, and an increasing prevalence of physician burnout.

The ACP’s Bob Doherty recently summarized an epic Health Affairs article devoted to fixing primary care. The bottom line was that paying primary care doctors better isn’t enough. The whole field needs to be re-invented.

That means a more team-like approach, with physicians taking a leadership role. Instead of seeing 30 patients daily, doctors can involve more mid-level practitioners, like physician assistants and nurse practitioners, for more direct patient care, while physicians can take a more supervisory role. Small pilot programs have found a decrease in burnout using this model.

But what if some doctors were resistant to this change? It’s a thought I hadn’t considered:

I wonder, though, whether primary care physicians “in the trenches” really want to have their practices re-invented. Most physicians, in my experience, are rugged individualists, and resist the idea of practicing as a member of a team. Moving away from what one article calls the “tyranny” of the 15-minute office visits sounds like a good idea –- but figuring out how to get there, and sorting out the respective roles of every member of the team, is another thing.

Maybe I’ve been fortunate with my collegial interactions, but most doctors I know embraces the team concept. Especially coming out of a medicine residency — where patient care is almost entirely team-based — newly-minted doctors shouldn’t have problems transitioning into this approach.

Perhaps solo practitioners may have some problems adapting, but it’s clear that this is where primary care is heading. How fast it’s implemented depends on how soon we can change the underlying payment system facilitating such a model.

*This blog post was originally published at KevinMD.com*


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