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.

"The cumulative time spent by specialists on routine chronic care is not trivial," says the study's senior author David C. Miller, MD, an assistant professor of urology at the U-M Medical School. "As a urologic oncologist, I take care of many cancer survivors. With a detailed care plan constructed by the treating oncologist, much of the follow-up care for these patients could potentially be assumed by a primary care physician-directed medical home, with appropriate referral back to me if problems or questions arise."

The study analyzed data from the 2007 National Ambulatory Medical Care Survey for seven chronic conditions: chronic obstructive pulmonary disease/asthma, low back pain, diabetes mellitus, coronary artery disease/congestive heart failure, chronic kidney disease and depression. Researchers examined the time specialists spent with patients for direct and indirect follow-up care for those conditions.

The study was funded by the Robert Wood Johnson Foundation Clinical Scholars Program and the Agency for Healthcare Research and Quality.