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Something Lost, Something Gained in Primary Care

Joe Cantlupe, for HealthLeaders Media, April 22, 2010

As a boy, I had a litany of allergies. Because of those allergies, and assorted other childhood ailments, my parents often took me to visit Saul Finkelstein, MD, at his pediatrician's office in Newark, NJ.

When I had to stay home, because of the flu or when I got the chicken pox, the good doctor came to our apartment. He had those big Clark Kent glasses, slick black hair, and a very authoritative voice. As I sat up in bed, he stuck a thermometer under my tongue, checked my chest, scribbled a prescription, and then he'd say goodbye. He carried out his black bag as he walked out the door, and was gone.

A primary school student at the time, little did I know that I was basically wrapped up in "primary care."

Across the country, the discussion continues about the primary care physician shortage, and the hardship of doctors trying to keep it all together in a small practice. The primary care physician is seen as a collective aging body.

Focusing on one element of the evolution of primary care, the New York Times reported a few weeks ago about a "quiet revolution" is taking place in healthcare, referring to an increasing number of young physicians opting against private practices and more older doctors selling their practices and moving in with other healthcare groups in bigger settings.

Mentioned briefly in the Times story was Parkview Health, a Fort Wayne, IN, health group that opened its doors for, among others, veteran doctors who sold their practice, and allowed them to remain in their buildings and hire staff there. The article noted that one physician who joined the Parkview staff had sold his practice across the street.

It's a sign of the times. Recently, I talked to three top officials of Parkview Health, who went beyond the small mention in the Times article, and gave some interesting insights and challenges of running a group in the immediate post-health reform era. They spoke highly of their reliance on running a tight executive board and committees in which physicians have great say.

And they maintained a firm belief in the evolution of primary care physicians, especially in the manner in which they run it, even though it's not practiced like the bygone day of my old physician, Finkelstein, a sole practioner.

The thing is—Parkview Health is growing like crazy.

Parkview Health is a not-for-profit community based health system that serves northeast Indiana, Western Ohio, and Southern Michigan and it is one of the area's largest employers with 7,500 full- and part-time employees, and has seven hospitals. In 2007, there were 45 physicians in Parkview Health, and now there are 175, an increase that is "pretty remarkable," says Ray Dustman, MD, a cardiologist and chief medical officer at Parkview.

In 2009, the Parkview Physicians Group was established, a physician-led and physician-governed division of Parkview Health, to, as Parkview officials tell it, "enhance the delivery of quality healthcare services." Parkview is not necessarily gobbling up the other physician practices in the area–that would mean there was some kind of forced maneuvers–but it is accelerating its numbers as independent physician practices go by the wayside. The Parkview strategy involves obtaining the best performing practices, not just the physician in the pre-retirement phase, or simply recruiting the newest physician in town, says Dustman, who is on the PPG board and manages the Parkview's cardiology business.

Referring to future hiring at PPG, Rick Henvey, regional chief operating officer at Parkview Health, observes, "We have about 50 to 75 [physicians] now in the pipeline, being evaluated/looked at, and we project another 50 or 75 the following year."

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