Dearth of Primary Care Docs Threatens Provisions of Medical Home Model

Shifting specialists' routine follow-up care to primary care physicians in a medical home model under the new federal healthcare reforms could save time, money, and free specialists for more complex patient care. However, the lack of primary care physicians could make such a policy difficult to implement, according to a new study by the University of Michigan Health System.

"I don't think anyone would question that there are too few primary care physicians," says John M. Hollingsworth, MD, an assistant professor of urology at the U-M Medical School, and a lead-author of the study, which appeared in the journal Medical Care. "The issue that came up in our study pertains to the role of specialist physicians in the new 'medical neighborhood.'"

According to the study, specialists spend more than 650,000 work weeks collectively on routine follow-up care for patients with common chronic conditions, such as asthma, diabetes, and lower back pain. Delegating a proportion of this care has the potential to create system-wide efficiencies by freeing specialists to concentrate on new patients and those with complex conditions.

However, redistributing half of the routine follow-up care would 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.