4 Medical Home Obstacles Facing Small Physician Practices

Nutting is no mere academic, lobbing grenades from an ivory tower. A family physician with more than 40 years experience in primary care and health services research, he was a founding director of the division of primary care with the Agency for Healthcare Research and Quality (AHRQ).

"When I trained, back in the 1960s and 1970s," Nutting told me, "it was a model in which the physician was everything. You would have a nurse and you, and that was it."   

"I have huge respect for primary care physicians, but they are going to have a huge challenge as they redesign their practices," Nutting says.

One of the major challenges for doctors who are either sole practitioners or have only a few colleagues on their staff " is the overreliance on the physician as being at the center of everything," Nutting adds. "The way primary care physicians have been trained, and the way they organize their practices, the feeling is, 'If you want to do something, you do it yourself.' You are thinking right out of the gate that the physician will be the center of it."

There are many examples reflected in small physician practices, he says. For instance, a patient may have an issue that he may want to discuss, but if it is nearing the end of an appointment and not an emergency, such a discussion may be put off. The doctor may say, 'Oh, by the way, make another appointment," Nutting says. "That isn't patient-centered, and we shouldn't pretend that it is."