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Addressing the Shift in Primary Care

By Paul B. Rothman, M.D.

We’ve all heard a lot in recent years about the state of primary care in our country and about the impending physician shortage. Having moved to Baltimore just over a year ago, I can now personally attest to just how hard it is to find a primary care physician … and I’m the dean and CEO. Now just imagine how hard it is—and especially how hard it will become in the future—for people who aren’t in such positions to find a doctor.

Patient-and family-centered care is a critical area of focus in the Five-Year Strategic Plan for Johns Hopkins Medicine. Our institution strives to be the national leader in the safety, science, teaching and provision of patient- and family-centered care.

We recognize that the need for primary care physicians will increase as more Americans become insured, as the number of individuals over age 65 increases, and as more people manage chronic medical conditions. 

Traditionally, fewer medical students at Johns Hopkins express an interest in pursuing primary care careers than at many other schools in this country. We are committed to changing that and are exploring additional primary care training opportunities for medical students and residents at our institution.

It will take more than that, though. It will take changing the culture so that primary care is perceived as being valued by academic leaders at our institution. We are committed to that as well. Two tactics, as noted in our Strategic Plan that are pertinent to this topic are:

  • Expand educational opportunities into community-based clinics, focusing on using Johns Hopkins Community Physicians practices to train medical students and residents in primary care and patient-centered home care.
  • Leverage the early momentum behind the Johns Hopkins Primary Care Consortium, a collaborative and multi-disciplinary coalition designed to improve primary care and health outcomes on a national level, to develop a “patient-centered primary care” track to the internal medicine residency program.

The Need for an Innovative, Collaborative Approach

During the age of health care reform, Hopkins and our peer institutions will be looked to for answers on how to address some of the greatest challenges and opportunities that we face in our own communities and as a nation, and chief among those concerns is primary care. 

Learn about our system-wide efforts to reinvigorate primary care

Hopkins, above all else, is known for its legacy of medical innovation and discovery. We must approach the issue of primary care with the same fervor for innovation that has led our greatest doctors and scientists to produce medical-first after medical-first for more than a century. We believe that the best answers will lie in the collaborative spirit that has hallmarked the greatest breakthroughs in medicine.

Primary Care’s Greatest Challenges

Medical students
Exorbitant student loan debt and relatively low reimbursement rates often deter medical students from careers in primary care.  

Before we can begin to solve the problem of primary care, however, we must first look at its causes.

We know from a recent JAMA study that most young doctors in training seek to become subspecialists rather than primary care physicians. Why? There are several reasons, but perhaps the greatest among them, as you already know, is the relatively low reimbursement rates that primary care physicians receive. They also endure lengthy workweeks that are equivalent or greater than those of doctors who subspecialize.

While we are actively pursuing ways to minimize the cost of medical education so that our recent graduates can feel free to practice in the field that they so choose without a harsh burden of debt, we also have to think about what can be done to change the way that we approach how primary care takes place. 

Of course, you also know that, across the country, young doctors are graduating with exorbitant student loan debt, and they likely reason that specializing will allow them to earn more money faster. They can sooner start families, buy homes and more fully engage in the practice of medicine.


Bringing Meaningful Change to Primary Care

In order for us to successfully change the way primary care takes place, we need to better partner with our patients and families on preventing illness.

  1. We can work to offer better education to those who require care.
  2. As I mentioned in a recent podcast, we can involve practitioners at every level of practice and depend on them to make decisions based on their respective levels of training, thus creating less demand for the primary care physician’s presence at every turn.
  3. We should continue to examine the profound possibilities of such teams, where nurse practitioners and other advanced clinical staff can help patients through a variety of problems. And we can be assured that they would be supported by seamless electronic health records that would foster continuity of care.
  4. Through technology, we will also inevitably discover untold opportunities to harness our collective knowledge to benefit patients at the primary care level. This, too, will help alleviate the potential damage of the impending shortage.
  5. To achieve all of this, everyone in the primary care field must be vigilant, and we must be determined to benefit from each other’s experience.

We know that no one answer will solve the problem, but we know that the best solutions will lie in the collaborative spirit that has hallmarked the greatest breakthroughs in medicine.