Health Care Reform Will Spur Primary Care Reform

I have no doubt that health care reform in Massachusetts is working. The physicians of our state can be proud of our role in enacting this program and in our ongoing commitment to implement it.

At the same time, health care reform’s success has brought to stark reality a shortage of primary care physicians, and almost everyone is feeling it. According to a recent survey reported in the Journal of the American Medical Assoc., just 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of fourth-year medical students plan to work in primary care. In 1990, that figure was 9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.

To ensure that health care reform keeps working, all stakeholders must unite to address that shortage, just as they did to enact reform in the first place.

In the short term, we need to slow the premature departure of established primary care doctors from practice. Enhanced reimbursement for primary care services is a key step toward that, and many models for doing so have been broached. Now is the time to vet and implement the best plan.

Another short-term focus should be reducing administrative hassles. All doctors face these burdens. We must intensify our work with the state and health plans to minimize paperwork.

Allied health professionals can certainly help ease the primary care crunch, and they make valuable contributions in the context of a team-based approach overseen by physicians. In today’s complex health care environment, the collaborative model with a doctor-led team enables allied health professionals to boost both the efficiency and timeliness of health care, while helping to ensure high-quality care.

How do we fund the revitalization of primary care? Preliminary data from other countries shows that, by enhancing primary care, overall health care costs will decline. Some of those saved resources could be channeled back into boosting the primary care system. While we cannot and should not rebuild primary care on the back of the subspecialist community, long-term reimbursement reform must address the dysfunctional, procedure-based models so that preventive medicine and coordination of care are duly reimbursed.

From Boston to the Berkshires to Washington, D.C., large and small coalitions are developing creative strategies for solving the primary care shortage. The legislation recently passed at the State House will go a long way toward increasing the ranks of primary care physicians.

As an optimistic, glass-half-full kind of person, I see the motivation to fix primary care as a fringe benefit of health care reform. If we pay attention to primary care now, in the long run people will be healthier, and costs will be controlled.-

Dr. Bruce S. Auerbach is president of the Mass. Medical Society, the statewide professional association of physicians and medical students, and the oldest continuously operating state medical society in the U.S. The MMS has more than 20,000 members and educates and advocates on behalf of physicians and patients throughout Massachusetts;

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