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Dome - Staying Attuned to Patient Care

Dome June 2014

Staying Attuned to Patient Care

By: Paul Rothman
Date: June 5, 2014

Paul B. Rothman
Paul B. Rothman, Dean of the Medical Faculty, CEO of Johns Hopkins Medicine

At Johns Hopkins, we produce the who’s who in health care and biomedical research. Yet when it comes to primary care, our 26th-place ranking means there is room to improve. It has to do, partly, with the types of patients we attract. We are largely a subspecialty referral center, and a lot of our training still takes place in the hospital.

But as medical educators, we must be responsive to society’s changing needs. For years, medical interest groups have been sounding the alarm about the shortage of family physicians in this country, particularly in rural areas. And it is only expected to get worse.

Consider the graying of our population. By 2030, one in five Americans will be considered elderly. About 80 percent of older adults have a chronic disease, and without an involved doctor managing their care, these patients become emergency room regulars. At the same time, the Patient Protection and Affordable Care Act has enabled millions more Americans to obtain insurance plans that cover checkups and other preventive services, spelling increased demand for frontline caregivers.

As one of the country’s leading academic medical centers, we are compelled to act. The first question we need to address: Why aren’t more young doctors choosing the primary care path? At Johns Hopkins, more medical graduates say they will pursue dermatology or ophthalmology than internal medicine, gynecology or family medicine. We need a surge of energetic new physicians to keep up with society’s needs, so how do we make primary care a more attractive option?

For starters, we need to elevate the status of primary care physicians. On the one hand, that means changing reimbursement so they are not earning a fraction of what their peers in subspecialties make. Unfortunately, we at Johns Hopkins don’t have much control over how much doctors get paid. What we can do is change the culture of our institution so that primary care is perceived as being highly valued by academic leaders. We can also help manage education debt so that students are free to choose less profitable career paths.

Our residents need more exposure to primary care practice and health policy leadership. We’re looking at how to accomplish this as part of our five-year Strategic Plan. In addition, we are exploring how to give more weight to clinical excellence in our professorial promotion process.

We also must pioneer ways to make primary care practitioners more efficient—through electronic medical records, better diagnostics, an expanded role for nurse practitioners and other means. And because all this will only get us so far, we are thinking beyond the small family doctor practice, finding innovative ways to deliver services through community pharmacies and other channels.

Although care coordination is a buzzword in medicine today, the best, most engaged primary care doctors have always doubled as choreographers. They are able to integrate ever-advancing knowledge from many different fields, alternately playing the role of cardiologist, dermatologist, psychiatrist, orthopaedist, urologist and more. Moreover, they combine such technical expertise with kindness, compassion and keen intuition. Primary care is complex, but few professional rewards can compare to the trusting relationships that grow when long-time patients believe that their “family doctor” is truly invested in their health.

To read more insights from Dean Rothman, visit