Memorial Hospital in Pawtucket has won federal funding to train more primary care doctors. The program is focused on caring for kids in poor communities. And the hope is that trainees will decide to stay on after their residencies. The grant will help residents see more children in the hospital's family medicine clinics, add mental health services, and teach residents more about the social determinants of health.
Rhode Island Public Radio’s Kristin Gourlay joins Elisabeth Harrison in the studio to talk about the growing importance of primary care in the health care industry.
ELISABETH: So Memorial Hospital got $1.25 million dollars from the federal government to beef up training for medical students and residents in primary care for kids mainly in Pawtucket and Central Falls – areas where there’s not enough access to primary care. But this is a hospital, where you think of going for emergencies and serious illnesses, not necessarily a routine physical or a sore throat. Why would a hospital want to get into the primary care business?
KRISTIN: The simple answer: to fill a need. There’s fairly widespread agreement in this state that we need more primary care doctors – especially for kids, and especially for underserved communities. Part of the problem is that primary care just doesn’t pay as well as other specialties. Plus we’ve got neighboring states like Massachusetts where pay is higher, so it can be tough to attract doctors to the field here. Providing more training in primary care right in the community where you hope to have more doctors is one way to try to solve that problem. That’s because residents sometimes end up staying where they train.
I should say that lots of hospitals already offer primary care services. But we’re seeing those services expand at a much faster rate now. Hospitals have been adding more and more primary care doctors, buying up primary care practices, and making arrangements with primary care providers and insurers to boost patient access to primary care.
ELISABETH: Why is that? Do hospitals have a financial interest in offering more primary care, or is this somehow better for patients?
KRISTIN: It’s a bit of both. Health care is undergoing a huge transformation right now. We’re seeing all kinds of new initiatives that pay doctors and health care providers for the quality of the care they provide rather than the quantity of care. This is the whole move from what people in health care circles refer to as a fee-for-service based system to a value or quality-based system. We’re also seeing a lot of efforts to reduce costly health care like hospital stays by keeping people healthier in the first place
But there’s a catch for hospitals: if patient stays drop, they need to figure out a way to make up the lost revenue to keep the doors open. So getting into the primary care business is a way to get a slice of the action. And if patients need specialty care, they might benefit from those referrals too.
ELISABETH: Hospitals aside, it sounds like you are seeing more of an emphasis on primary care in general.
KRISTIN: Yes. It’s really becoming the center of health care delivery – or at least, that’s what the Affordable Care Act is promoting. That’s a big focus of Rhode Island’s attempt to quote “reinvent” Medicaid. We’re asking primary care doctors to do more and more: to be the first stop for patients, and to be their one-stop-shop for health care. You’re seeing primary care practices with highly skilled nurses, maybe a nutritionist, mental health professionals, and other providers on staff to provide a more holistic kind of care, all under one roof. Primary care practices are increasingly paid based on how well they manage a patient’s chronic disease and keep them out of the hospital. They’ve got nurse care managers who can help patients manage their medications or solve other problems that keep them from staying healthy. And they’re doing that over the phone and even sending caregivers to patient’s home.
In my mind it’s kind of a return to an old idea: the family doctor, who sees you for everything, and even makes house calls.
ELISABETH: If primary care doctors are kind of a lynch pin for health care reform efforts, is this good for patients?
KRISTIN: If more people have access to primary care doctors, and they’re able to stay healthier and out of the hospital because of that, that’s of course a good thing. Not only for the patient, but also for everyone who pays for health care. That could bring overall costs down. Our health insurance rates go up every year, in part, insurers say, because the cost of health care keeps going up. So reining in those costs would help everyone.
But when it comes to relying on a primary care doctor more, and whether that’s a good thing for patients...in my own experience, it’s a good thing. I like the idea of establishing a long term relationship with a primary care doctor, a partner. That doctor gets to know me, my history, can spot trends over time. And then if there’s a crisis of some kind, I’m not starting from scratch with someone.