Primary care practices reallocate staff to fight provider shortages
Princeton, NJ – As the shortage of primary care providers is becoming more of a threat to healthcare organizations, a new national program has been created to help identify primary care sites around the country that are using their workforce creatively in order to increase access, provide good quality care and create value at their institutions.
The Robert Wood Johnson Foundation (RWJF), in Princeton, N.J., has teamed up with the Group Health Research Institute to work on The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project), which will identify primary care practices that use health professionals and other staff in ways that maximize access to their services, so these workforce models can be replicated and adopted more widely across other healthcare organizations.
“Our system can’t produce enough primary care providers over the next couple of years to meet the demand of what we need, so what we’re going to have to do is use people more creatively,” said Maryjoan Ladden, RWJF senior program officer. “This might involve using a medical assistant in the practice to do initial medication histories on patients or training them to do counseling around self-management and using medications appropriately.”
Ed Wagner and Margaret Flinter are co-directors of The Primary Care Team, and the MacColl Center for Health Care Innovation at Group Health Research Institute in Seattle will serve as its national program office. Wagner is director of the MacColl Center and Flinter is a family nurse practitioner by clinical background and a senior vice president and clinical director of the Community Health Center, Inc., in Connecticut.
“Primarily, we’re looking for innovative ways in which the non-physician members of practice teams are involved in the care and support of patients because there is growing evidence that these members make a major difference in terms of how well patients actually do,” said Wagner. “With the nursing shortage several years ago and upgraded nurse salaries, nurses are becoming less common in primary care practices because of their cost. What we’re looking for is to what extent can people with less formal training than nurses play in some of the important roles that nurses would normally play.”
According to Ladden, RWJF has a National Advisory Committee, chaired by Thomas S. Bodenheimer, adjunct professor at the University of California School of Medicine in San Francisco, that will develop and apply the criteria for selecting the exemplary primary care practices, which will represent a variety of settings, practice configurations and locations. A research team will conduct site visits and then the sites will join together in a learning community to share best practices and to help distill their innovations into a toolkit that can be used by others.
“We collected around 400 nominations for healthcare practices, which will eventually be narrowed to 30 for a more intense study for two-and-a-half years,” said Ladden, noting that the criteria used to narrow the field will include patient and staff satisfaction, the creation of more access to care and creativity in staff use and training.
Ladden said RWJF hopes to learn a lot from the 30 chosen healthcare organizations when it comes to changes that were made in staffing and practical lessons on how to change job descriptions and introduce these new innovations to patients at the practice.
Primary care is very diverse. Practices can be as small as one doctor or nurse or can be large and very complex,” said Wagner. “We want to study all of that.”
Initial RWJF funding will support The Primary Care Team through June 2014.