A Day in the Future of the Primary Care Physician's Office?

In the primary care future as we and others envision it — and as a few pioneers are beginning to create it — a day in a primary care office would begin with a team huddle of medical assistants (MAs), registered nurses (RNs), nurse practitioners, physician assistants, front-desk staff, behavioral therapists, clinic managers, social workers, nutritionists, and physicians. The team would discuss the day's patients and their concerns. They would review quality metrics, emphasize their quality-improvement cycle for the week, and celebrate the team's progress in caring for its community of patients. Because everyone would feel responsible for patients' health, coordinating care and teamwork would take on new importance.

Kathleen Barnes, Jason Kroenig-Roche, and Branden Comfort, Harvard School of Public Health, Oregon Health and Science University Family Practice Residency, and University of Kansas School of Medicine,“The Developing Vision of Primary Care,” New England Journal of Medicine, September 6, 2012

September 11. 2012 -    As David Lawrence, MD. Chairman Emeritus Kaiser Permante, explained in his book, From Chaos to Care: The Promise of Team-Based Medicine (Perseus Publishing, 2002), team-based practice may be the wave of the future.  

But it takes an organization to pay the team, which will surely be expensive to recruit and  support.  It takes money to hire a team of MAs, RNs, PAs, behaviorial specialists, clinic managers, social workers, nutritionists, and primary care physicians to quarterback the team.  It may take a dozen or more other professionals to support one primary care physician and to "integrate" and "coordianate" care.

How does one recruit such a team? Will it take the federal government subsidizing teams in community health clinics?   How  does one persuade the team  to function in  disparate  geographic settings, which may be rural or in depressed inner cities,  where heretofore in many cases,  a solo doctor and his nurse or a small group, familiar with their patients and their families.  have provided 90% of the services needed? What is the most efficient way to do this?   And where are  the cost-benefit analyses  that indicate such a team approach is affordable?

Tweet:  A team-based approach to primary care, requiring a minimum of 12 health professionals is expensive to recruit and support. Who pays?