Primary-care shortage puts medical home model out of reach

The country may not be ready to shift to a primary-care medical home model, according to a University of Michigan Health System study published in Medical Care, because, simply put, there aren't enough primary-care doctors to handle the workload.

Under the medical home model, the work would be redistributed so that specialists would be freed up from spending a significant amount of time handling routine follow-up care for patients with chronic conditions. Instead, primary-care physicians would more cost-effectively handle the follow-up.

Specialists spend more than 650,000 work weeks collectively-on routine follow-up care for patients with common chronic conditions, such as asthma, diabetes or low back pain. Delegating some of this care could make the system more efficient by freeing up specialists to concentrate on new patients and those with complex conditions.

However, redistributing half that workload could require an influx of thousands of new primary-care doctors, or an extra three weeks of work annually from primary-care physicians in the current workforce, the study found.

The medical home model shifts emphasis from rewarding volume via fee-for-service to rewarding quality of outcomes using performance measures. The model calls for primary-care doctors to coordinate and manage their patients' medical care across multiple locations and settings. The approach should save money by delegating less complex aspects of care to primary-care physicians.

But with primary care fast losing ground as the preferred field of practice, reformers who want to see the patient centered medical home model get off the ground may have to wait a long time.

To learn more:
- read the University of Michigan Health System press release
- read the abstract from the journal Medical Care

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