Healthcare reform will emphasize the medical home model, but the nation may not have enough primary care doctors to handle the workload, according to a study by the University of Michigan Health System.
The study, published online in the journal of Medical Care, was funded by the Robert Wood Johnson Foundation Clinical Scholars Program and the Agency for Healthcare Research and Quality. It examined data from the 2007 National Ambulatory Medical Care Survey for seven chronic conditions – chronic obstructive pulmonary disease/asthma, low back pain, diabetes mellitus, coronary artery disease/congestive heart failure, chronic kidney disease and depression. Researchers examined the time specialists spent with patients for direct and indirect follow-up care for those conditions.
"I don't think anyone would question that there are too few primary care physicians," said John M. Hollingsworth, MD, an assistant professor of urology at the U-M Medical School and the study's lead author. "The issue that came up in our study pertains to the role of specialist physicians in the new 'medical neighborhood.'"
"Policymakers need to consider the scope and magnitude of care for which specialists are currently responsible in these delivery system reforms," he said.
According to the study, specialists spend a significant amount of time each year – more than 650,000 work weeks collectively – on routine follow-up care for patients with common chronic conditions such as asthma, diabetes and low back pain. But redistributing half of that workload could require either thousands of new primary care doctors or an extra three weeks of work a year from the primary care physicians in the current workforce, the study found.
U-M researchers examined the implications of redistributing the chronic disease care workload among specialists and primary care physicians under the patient-centered medical home model of care.
The model places an emphasis of having primary care doctors coordinate their patients' medical care across multiple locations and settings, thus saving costs. The approach is an important part of the recent healthcare reform legislation and is becoming an increasingly popular solution to the current fragmentation and inefficiencies in the healthcare delivery system, the authors said.
Delegating a proportion of this care has the potential to create system-wide efficiencies by freeing up specialists to concentrate more on new patients and those with complex conditions, according to the authors.