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In today's post, family physician and regular Progress Notes contributor Andrew Selinger details the many changes currently underway in health care and primary care.

By H. Andrew Selinger, M.D.

As a family physician struggling to practice according to the new paradigm of population health management, I am stretched to the limit of my comfort zone. When I graduated from the University of Pennsylvania  School of Medicine in 1983, the overarching goal was to learn as much as I could in my chosen field of practice, pay close attention to my patients’ clinical histories, examine them thoroughly and order whatever tests (taking advantage of emerging technologies) would  provide me with the necessary information to effectively address their complaint(s). I was then expected to prescribe the recommended treatment(s) from the growing choice of medications and therapies available. The expectation for our profession was that we would keep up with the literature to always provide our patients with the most current health care treatment recommendations. At the time, this was truly patient-centered medical care. 

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Posted by Sonya Collins on Oct 30, 2014 1:31 PM EDT
Last month, PCP chapter leaders from around the country met in Cambridge, MA, for the third annual Gregg Stracks Leadership Summit. They shared stories of the challenges of pursuing a career in primary care in an educational system and in a health care system that usually don't value that choice. They learned community organizing skills that will help them harness the passion and talents of fellow primary care advocates across professions to raise the profile of primary care on their campuses and in the health care system. In the coming weeks, we will read stories by summit participants. Here's one of them.

By Catherine "Katie" Derington

Having never been to a conference before, I didn’t have many expectations before PCP’s third annual Gregg Stracks Leadership Summit. I just hoped to learn a lot, get inspired, and have fun. Specifically, I wanted to learn about how to grow as a leader, inspire others, work more effectively in teams, and handle conflict with those who may not share my vision.
 
My list of apprehensions, however, was longer than my list of expectations: being in a new city, catching flights, icebreaker activities, appearing like a naïve student, making good impressions, not being taken seriously as a student, studying for the multitude of quizzes I had the next week, and finding time to sleep.
 
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Posted by Sonya Collins on Oct 28, 2014 11:35 AM EDT
Last month, PCP chapter leaders from around the country met in Cambridge, MA, for the third annual Gregg Stracks Leadership Summit. They shared stories of the challenges of pursuing a career in primary care in an educational system and in a health care system that usually don't value that choice. They learned community organizing skills that will help them harness the passion and talents of fellow primary care advocates across professions to raise the profile of primary care on their campuses and in the health care system. In the coming weeks, we will read stories by summit participants. Here's one of them.

By Rebecca Sedillo, F.N.P.

On my first day of a clinical rotation at a community health clinic in Phoenix, AZ, nursing students, med students, interpreters, and primary care providers huddle in the back room to present history and physical exam findings to our M.D. preceptors. In between patients, one of the med students starts chatting me up. “You’re a nurse practitioner student? Cool, my mom is a nurse. Wait, what’s the difference between a nurse and a nurse practitioner?”

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Posted by Sonya Collins on Oct 23, 2014 10:31 AM EDT
The 2014 Hotspotting Mini-Grant Project gives health professional students an unprecedented hands-on opportunity to practice an innovative model of care delivery called hotspotting. Hotspotters identify health care super-utilizers --  people who are admitted to the hospital multiple times a year, frequently for avoidable complications of chronic conditions, and who often have social barriers to adhering to their care plan. The hotspotters proactively bring additional attention, follow-up, resources and care to these patients in their homes and communities to help keep them out of the hospital. Student hotspotters will share their experiences here twice a month for the rest of this year in “Notes from the Hotspotters.”

By Meg Lagunas

I had a 17-year-old brother with Prader-Willi Syndrome who required the care of numerous specialists.  Each specialist was individually an great health care provider who worked hard to give the best care possible to my brother and family, but each of these specialists only worked within their own specialty, their own body system, their own silo. 

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Posted by Sonya Collins on Oct 21, 2014 11:56 AM EDT
This family doc highlights the ways in which Medicare's payment for graduate medical education doesn't guarantee the country gets the types of doctors it needs.

By Kenny Lin, M.D.

The Institute of Medicine released a report in July that recommended significant changes to the way Graduate Medical Education (GME) is financed. The report, “Graduate Medical Education That Meets the Nation’s Health Needs,” is by a 21-member expert committee formed to conduct an independent review of the governance and financing of the system. The report “provides an initial roadmap for reforming the Medicare GME payment system and building an infrastructure that can drive more strategic investment in the nation's physician workforce,” including accountability requirements for institutions to meet workforce needs, particularly primary care graduates.

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Posted by Sonya Collins on Oct 16, 2014 10:17 AM EDT
PCP's annual Gregg Stracks Leadership Summit gives participants the opportunity to plan advocacy events and campaigns on their campuses. Harvard Medical School chapter members took the opportunity to plan the outreach strategy for their upcoming event -- a town hall that boldly asks the question, "What would the future of Harvard Medical School look like with family medicine?"

By Andreas Mitchell

In less than a month, Harvard is hosting an unprecedented event called “What Would the Future of Harvard Medical School Look Like with Family Medicine?" I am excited to see my school – which has no family medicine clerkship, department, or residency program – open up a dialogue about the possibilities for family medicine at a university that strives to lead health care reform efforts. 

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Posted by Sonya Collins on Oct 14, 2014 11:01 AM EDT
In honor of National Primary Care Week 2014, we're running blog posts all week that recognize underserved and marginalized communities and the primary care providers that serve them. 

By Anthony Fleg, M.D., M.P.H.

From the second Tim came into the emergency room, he was labeled “alcoholic.” Tim had had two alcohol-related hospital admissions in the last month. As a family medicine intern, I should have looked deeper, but admittedly, I, too, defined him by his addiction. On the night before leaving the hospital this third time, he asked the nurses if he could borrow a pen. He worked all night using a scrap of paper to draw up his vision of wellness and sobriety. And as he walked out of the hospital the next day, he handed me the drawing (below), letting me know that "artist" is the trait he would prefer to be known by, should he come to our hospital again.

The experience had a profound influence on me. Why hadn’t any of us, in the span of three hospitalizations, realized that Tim had a set of strengths that, if identified, would be more important to his recovery than our endless lectures on liver damage or AA meetings? Why had no one asked him what he dreamed of doing instead of living from drink to drink? 

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Posted by Sonya Collins on Oct 9, 2014 10:46 AM EDT
In honor of National Primary Care Week 2014, we're running blog posts all week that recognize underserved and marginalized communities and the primary care providers that serve them. 

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.

Many people, including me, are thinking about how to build the future health care workforce that we need to keep Americans healthy. How do we train more primary care providers? How do we encourage them to work in the communities where their services are needed most?

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Posted by Sonya Collins on Oct 7, 2014 9:39 AM EDT
This year National Primary Care Week honors advocacy for marginalized and underserved communities. We're kicking off the week by telling you about the 2014 Hotspotting Mini-Grant Project, a program that helps students care for underserved patients in their community in an innovative way. 

By Sonya Collins

This summer marked the launch of the 2014 Hotspotting Mini-Grant Project. The initiative, a collaboration between Camden Coalition of Healthcare Providers (CCHP), the Association of American Medical Colleges (AAMC), and Primary Care Progress (PCP), gives health professional students an unprecedented hands-on opportunity to learn and practice an innovative model of health care delivery called hotspotting.
 
Hotspotting, developed for use in health care by family physician Jeffrey Brenner (top left) of CCHP, identifies health care super-utilizers and invests more time and resources in them in order to keep them out of the hospital. Brenner was inspired by the method former NYPD Commissioner William Bratton devised to cut crime in New York City. He focused more resources in the areas that had heavier crime. 

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Posted by Sonya Collins on Oct 6, 2014 10:52 AM EDT
Participants in PCP's 3rd annual Gregg Stracks Leadership Summit in Cambridge, MA, last weekend got to hear a panel discussion on building coalitions to transform primary care. Health care system innovator Jeff Brenner skyped in to join the panel. If you missed it, you've got to see what this family doc is all about! Here's a story about him from our archives.

By Sonya Collins 

“You’re too smart for primary care.” Every primary care provider-in-training has heard it before. But Jeffrey Brenner, a family physician in Camden, NJ, has just proven that there is no ceiling for intellect in this profession. He’s been named a “genius.”
 
Last month [September 2013], the 44-year-old founder and executive director of Camden Coalition of Healthcare Providers won a prestigious MacArthur Fellowship, also known as “The Genius Grant,” in the amount of $625,000 that he can spend however he pleases. The award is recognition for his innovative “hotspotting” model of care, which identifies the sickest and most expensive patients in the health care system and makes targeted interventions in order to stop medical complications before they occur to avoid unnecessary ER visits and hospital admissions and drastically lower health care costs.  more...
Posted by Sonya Collins on Oct 2, 2014 11:23 AM EDT
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Most Recent Comments

Thanks Rebecca for your contribution with this post, for your work as an FNP and PCP member, and your powerful affirm...
Kenny, Thank you for this well written piece -- I think every Chapter should know where they stand in terms of the rati...
Katie - I too loved this post, and really appreciate your perspective on the importance of all of us "popping up" to le...
Katie! This post is so inspiring; thank you so much for writing this. I'd love to hear your thoughts about how we get mo...
Thanks, Rebecca! I can totally relate to your story. As a college senior, two different family medicine physicians...

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