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Many members of the PCP community attended the Direct Primary Care Summit in Arlington, VA, this summer. We're sharing some of their perspectives here.

By Diana Huang

Like many students, I applied to medical school with the goal of helping others. I started classes unsure of what kind of medicine I wanted to pursue, but as time passed and I learned more about the state of health care, I came to the conclusion that the best way to make an impact on the nation’s health and on my future patients was to become a primary care provider. At that point, my dream of becoming a family physician, with the privilege of forming relationships with whole families over the years, was born. I wanted not only to follow that path myself but to inspire others to join me as well, doing my own small part to help shift the primary care physician-to-specialist ratio in the United States.

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Posted by Sonya Collins on Sep 11, 2014 10:58 AM EDT
As both the number of insured people in the U.S. and the diversity of our population grow rapidly, family physian Kenny Lin points to the need for a physician workforce that reflects that diversity.

By Kenny Lin, M.D.

Since joining my practice two years ago, I've noticed that I care for a disproportionate number of immigrants of Chinese and other Asian descent compared to my colleagues. Although both of my parents were born in Taiwan, I don't speak Mandarin nor do I have special expertise in medical conditions common in Asian Americans. Nonetheless, Asian patients seem more comfortable with me. U.S. health workforce analyses show that underrepresented minority physicians (black, Latino and Native American) are more likely to provide primary care and more likely to serve medically underserved populations. From a research standpoint, a diverse workforce of physician-scientists and physician-researchers will give rise to more diverse research and innovation to solve the problems of a diverse population.

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Posted by Sonya Collins on Sep 9, 2014 11:36 AM EDT
Today's post comes from our collaboration with Medstro, who is hosting the 2014 Primary Care Challenge live event co-sponsored by PCP. Like PCP, Medstro values clinical innovation in primary care. So we suggested a Q&A with our own CIN fellow Peter Meyers for Medstro's innovation series in their online publication MedTech Boston

Q&A with Jenni Whalen, managing editor of MedTech Boston, and Peter Meyers, PCP CIN Fellow


JW: First, tell us about Primary Care Progress’s Clinical Innovation Network (CIN). What do you do as the CIN content fellow? 

PM: CIN has two divisions: content and community. As the content fellow, my main responsibility is organizing and moderating online webinars aimed at medical students and residents. Our goal is to bring our audience to the cutting edge of innovation. The CIN community fellows work with local Primary Care Progress chapters to determine their understanding of clinical innovation, their areas of interest, and opportunities for improvement.

The big idea here is that we believe in connecting students to national and global ideas, helping them understand the context and relevance of their own local work. If we can connect students to interesting things happening at the national or global level, show them how it relates to their own communities, and give them to the tools to make an impact, a few of them might be motivated to become leaders in the field. That’s what we’re trying to do: motivate and train the next generation of leaders in primary care.

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Posted by Sonya Collins on Sep 4, 2014 11:26 AM EDT
Putting off her own routine preventive care, this nurse practitioner realized that follow-through isn't easy for patients. She tries to remember that during every patient visit.

By Katrin Moskowitz, N.P.

Before I started my nurse practitioner program, I was happy with where I was in terms of my health. I was at a great weight; my diet was free of any processed sugars and grains, and I worked out several times a week. By the time I started clinicals in my primary care site, however, I felt like a hypocrite. I had not seen my primary care provider in two years or my gyn in three – but at least I was up-to-date on my dental visits! My diet was filled with bad on-the-go choices; my full-time job was now a work-at-home position; the gym was a foreign place, and my weight was creeping up and up and up.

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Posted by Sonya Collins on Sep 2, 2014 1:39 PM EDT
Many primary care practices wish to become patient-centered medical homes, but the transformation process can be daunting. Here, three experts offer some professional advice.

By Joan D. Johnston, R.N.; Jaime Vallejos, M.D.; and Jeanne Cohen, R.N.

As soon as we walked through the doors of the urban community health center that we were going to help achieve patient-centered medical home recognition, we saw a practice that was passionate about obtaining the recognition, but overwhelmed to the point of paralysis. We are a team of certified patient-centered medical home content experts from the University of Massachusetts Medical School. In our work with health care organizations and practices seeking recognition from the National Committee for Quality Assurance (NCQA), we are always reminded that achieving this designation requires thoughtful planning, strategy and commitment. Through hard work and with our support and guidance, the community health center achieved Level 2 recognition from NCQA. And they learned it doesn’t have to start out so difficult. 

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Posted by Sonya Collins on Aug 28, 2014 11:21 AM EDT
As a National Health Service Corps scholar, Kohar Jones was required to serve for a few years after residency in a federally qualified health center. After her service was complete, the medical director was surprised that Jones planned to stay. Here, she explores ways to create practice settings that primary care providers won't want to leave.

By Kohar Jones, M.D.

Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death cost a lot, and our country can go broke in the process. We save money and lives when everyone sees a primary care doctor who works to keep people well. But we don’t and won’t have enough primary care providers in the United States to meet the needs of all those who now have access. We’re already facing a shortage. The Affordable Care Act is only going to make it worse.

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Posted by Sonya Collins on Aug 26, 2014 12:05 PM EDT
At Primary Care Progress, we believe that innovation can transform primary care from a field that breeds burnout to a field that brings joy to its practitioners. Students, trainees, and young clinicians should be leaders of such innovation. In this piece from our archives, two med students describe a program that trains future doctors to be innovators, too.

By John Luo and Jeffrey P. Guenette

Technologies in the field of medicine have grown exponentially in the past few decades. Stemmed by a growth in our knowledge of disease pathology, incentives from governmental granting agencies for translational research, and rapidly advancing technical and engineering capabilities, the role of the physician as innovator has never been more important. Physicians have played a significant role in the creation of a wide variety of medical tools from drug therapies to electronic health records. It is estimated that over 20 percent of all patented medical devices were invented by physicians. And, perhaps surprisingly, roughly 60 percent of physician-inventors are at private practices versus in academic settings, according to a Duke study

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Posted by Sonya Collins on Aug 21, 2014 11:15 AM EDT
Even after your formal training is complete, this family physician says it's still normal to ask yourself, "When will I feel like a real doctor?" 

By Randi Sokol, M.D., M.P.H.

In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question.
 
As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming one diagnosis or management strategy without considering other less obvious possibilities. Much like House in his intellectual detective-like pursuit, we are taught to order every test, no matter how obscure, until we can solve the case. 

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Posted by Sonya Collins on Aug 19, 2014 11:44 AM EDT
Robin Williams' death this week reminds us that mental health conditions are often unseen. What's more, our health care system is designed in a way that allows people living with these conditions to fall through the cracks - their problems only visible to others when it is too late. In this post from our archives, Benjamin Miller explains how this happens and how we can stop it.

By Benjamin Miller, Psy.D. 

Imagine this scenario. You go to see your longtime primary care provider. What you have to say you could only say to the person who has taken care of you and your family for years, has seen births and deaths. It’s still hard to say. In fact, you never thought you’d have to say it. But ever since you lost your mother, you’ve not been feeling your best. You’re eating foods you know aren’t good for you. You’re sleeping too much and not exercising at all. Your blood pressure is the highest it’s ever been, and your weight is becoming a problem. You feel down most of the time, and you’ve stopped doing the things you love. It was actually your neighbor that asked, “Are you depressed?” 

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Posted by Sonya Collins on Aug 14, 2014 12:16 PM EDT
Many members of the PCP community attended the Direct Primary Care Summit in Arlington, VA, this summer. We'll be sharing their perspectives here over the coming weeks. Today a medical student questions the accessibility of direct primary care.

By Brett Clark

One of my main interests in primary care is providing care to all people, regardless of their income or ability to pay. In my limited experience with health care, I have found it most rewarding to work with the underserved and underprivileged, those who do not have their own money available to allocate to health care. These patients are on Medicaid or are at the mercy of free clinics. This is why I have always had a poor opinion of concierge medicine. In this model, patients pay an annual fee or a retainer to their primary doctor in exchange for their medical care, and they may incur additional charges for labs or when their care exceeds the retainer. This is care for people who can pay for it. 

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Posted by Sonya Collins on Aug 12, 2014 9:55 AM EDT
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Thanks, Dr. Lin! I really appreciate your perspective on this issue. The post reminds me of the buzz about teaching "...
Brett, Very well written commentary. Excellent questions raised. Dr Q, your response is thoughtful and helpful. I...
Thanks for your candor and honesty! I think the best clinicians (primary care or otherwise) all possess an ability t...
Great observations. I hope your self-care has sustained you through your last year of residency and beyond, and you...
My colleagues and supportive interprofessional team influenced my decision to stay. I appreciate having a psycho...

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