There is an ongoing debate in the United States about whether we will have enough primary care clinicians to meet the future demand for primary care and, if there is a shortage, how to solve it. But the debate misses a critical question: Are we meeting the current demand for high-quality primary care?
The answer is that, too often, we are not providing high-quality primary care, especially for the 1 in 5 US adults with a mental illness or those with substance abuse and other behavioral problems. Most primary care practices are not equipped to care for them. Many of these and other primary care patients have chronic conditions, which a lack of behavior change support and timely mental health care may exacerbate.
Practices that embrace a high-functioning practice team model can meet more of these chronic care and behavioral health needs. With a high-functioning practice team, the following things are possible:
Medical assistants, nurses, and other staff provide preventive and chronic services to patients, enabling them to receive more care at each visit.
Team members can proactively identify and reach out to patients who need services, have missed appointments, or need follow-up care between visits.
Primary care clinicians can see more patients because they have more time to focus on issues most in need of their expertise.
Studies suggest that a physician or nurse practitioner cannot provide this kind of care alone unless they are working 22 hours a day.
If government projections are correct, we may need to find a way to meet these needs with a declining primary care workforce. The US Health Resources and Services Administration projects a shortage of 20,400 primary care physicians by 2020, if the system for delivering care remains the same. Proposed solutions to the projected shortage include extending the scope of practice of nurse practitioners and physician assistants, training more primary care physicians, and leveraging technology to reach more patients via telemedicine. I believe that team-based care is the solution that will have the most immediate and biggest impact on the projected provider shortage.
Developing a high-functioning health care team leads to better care, even if we have enough physicians. It’s not just about filling in the gaps. We have strong evidence now that including other clinical professionals leads to better outcomes, including physician and staff satisfaction. To help build high-functioning health care teams, I’m delighted to be a part of IHI’s 12-month Collaborative, “Optimize Primary Care Teams to Meet Patients' Medical AND Behavioral Needs,” starting in February 2015. One focus of the program is helping practices integrate behavioral care into primary care. The second focus is improving the effectiveness of patient care teams, not just for behavioral care, but also for patients’ other medical needs. The content and approach for this Collaborative focus on insights derived from careful study of exemplary primary care practices across the United States, as part of a national program of The Robert Wood Johnson Foundation called Primary Care Teams: Learning from Effective Ambulatory Practices (PCT-LEAP).
The conversation needs to shift. Even if we have enough primary care providers, are we putting together the right constellation of expertise and energy to care for the population? The answer is: only if we build effective practice teams.
Dr. Ed Wagner is Emeritus Director of the MacColl Center for Healthcare Innovation and Senior Investigator at the Group Health Research Institute. He was faculty for IHI’s Optimize Primary Care Teams to Meet Patients' Medical AND Behavioral Needs Collaborative.