The nation is facing a significant shortage of physicians, particularly in rural areas. In fact, the shortage is estimated by the American Medical Association to fall between 37,800 and 124,000 physicians within the next 12 years. From primary care to psychiatry, obstetrics, neurology, and oncology, numerous specialties are facing a physician shortage. And with more and more physicians retiring and quitting from burnout, the problem isn’t getting better.

Rural areas face the brunt of this shortage as urban areas have higher densities of both primary care physicians and specialists. Patients in rural areas tend to be older, poorer, and sicker, especially with chronic conditions. With fewer doctors around, they have to travel further for both preventative and emergency care, putting them at greater risk for poor health outcomes and mortality.   

The mismatch between medical school enrollment, residency slots, and the need for physicians in the workforce has resulted in a lose-lose situation where perfectly competent physicians face barriers to working while simultaneously, entire regions of the country are without sufficient access to physicians.

What can we do about this mismatch and resulting dilemma?

Increase residency opportunities through both federal and state funding

Most residency slots are funded by the Centers for Medicare & Medicaid Services (CMS), meaning that they need action by the federal government for expansion. This also means that no significant action had been taken for over 20 years (Congress had actually capped the number of residents), until the COVID-19 relief bill was passed. The COVID-19 relief bill opened the door for 1,000 new residency slots, 10% of which must be in rural areas. Another similar bill has been introduced in Congress that would allocate funding for an additional 2,000 residency slots every year for 7 years starting in 2025.

Another option is to increase residency slot funding on the state level. The majority of doctors stay in the states where they completed their residency. Both California and Texas–where the shortage is predicted to be the worst–approved multimillion dollar expansions in funding, resulting in increase retention of physicians in underserved, local areas. 

The Assistant Physician model

Missouri took a different approach, passing a law that launched a new category of licensure called assistant physicians (not to be confused with physician assistants). This allows medical school graduates who didn’t match to a residency on their first try to practice primary care in rural and underserved areas under the supervision of a licensed physician. While the program is relatively new, there is evidence it’s working at alleviating the rural physician shortage. As of early 2023, there were nearly 300 assistant physicians licensed in the state, about 3% the number of primary care doctors. Six other states now have similar laws allowing for unmatched medical school graduates to practice while they continue trying to match with a residency. Washington specifically designed their program for international medical graduates. 

The physician shortage in rural areas is a complex problem with numerous potential solutions. We need to increase the number of licensed medical professionals–including nurse practitioners, physician assistants, and international medical graduates–as well as retaining them. We need to reduce burnout so clinicians don’t hate their jobs and retire early. We need to incentivize trainees to serve in medical deserts where they’re needed the most. 

The realignment of community needs and the physician workforce pipeline will be tricky, but not impossible. While telehealth may help in the coming years, we should still be considering the most efficient way to build up our healthcare practitioner workforce.

The post How can we fix physician shortages in rural America? appeared first on Lown Institute.

That’s what Dr. Michelle-Linh Nguyen, an internal medicine physician at the University of California-San Francisco, heard from her attending physician once during residency. As Nguyen writes in an essay in KevinMD, this feedback left her shocked and disillusioned– but the event soon sparked her to question why we put so much stake into primary care metrics when they often aren’t measuring what matters most.

She writes, “Ideally, core measures would represent the values of patients, support primary care providers, and promote care that is valuable to patients, communities, and physicians. Unfortunately, pairing metrics with payment can create an environment where physicians and clinics are led to approach primary care as a checklist of measures rather than focusing on relationship-building and responding to the concerns of patients and the local community.”

Nguyen notes that primary care is often undervalued within health systems as well. Rankings like the Lown Institute Hospitals Index that measure value and civic leadership could give credit to hospital systems that have a more equitable pay balance between generalists and specialists, and minimize administrative burden for their primary care physicians.

“A hospital systems’ support of their primary care physicians and clinics speaks to their dedication to serving their patients and communities over making profit.”

Michelle-Linh Nguyen

One result of our current payment model is that doctors who spend more time with their patients actually make less money, a pattern that disproportionately affects women. A recent study on the gender pay gap in primary care shows that in 2017, female primary care physicians spent 20 more hours with patients than their male colleagues at the same practices. But because they had fewer patient visits and spent more time with each patient, their average pay was $39,000 less.

Rather than rewarding doctors for seeing more patients and hitting certain targets, we should be rewarding them for taking the all the time with their patients that they need to build trusting relationships. This will require a significant shift in how we pay doctors: moving away from fee-for-service payment and reevaluating the metrics we currently use to determine quality.

The post What do we value in primary care? appeared first on Lown Institute.

But don’t despair–in the latest edition of NPR‘s Life Kit series, Lown Institute Senior Vice President Shannon Brownlee, patient advocate Liz Salmi, and Johns Hopkins surgeon Marty Makary offer some tips on how patients can maintain control over their health care in stressful situations. The segment was hosted by Georgetown University family medicine physician Mara Gordon and general internist and President of the University of Oklahoma John Schumann.

Listen to the radio piece on NPR here!

Salmi used her story of receiving a diagnosis of brain cancer to illustrate some of the challenges in dealing with the health care system. “The words of what you have are delivered in really technical speak. They don’t say, you have brain cancer. They say… you have a grade two astrocytoma,” said Salmi. Other challenges include not knowing which doctor to contact about which issue, getting access to doctors’ notes, and learning all of her options before making treatment decisions.

“Any doctor who doesn’t want you to get a second opinion is a doctor you shouldn’t be seeing” — Shannon Brownlee

The panelists emphasized the importance of having a primary care doctor be the center of your care team. “We have primary care doctors who want to be in the loop of everything that happens with that patient. You want someone who’s fighting for you like that,” said Makary.

However, when making a major treatment decision, getting another doctor’s opinion is key. “Any time you are told, you need a seriously invasive procedure, you need a second opinion,” said Brownlee. “Any doctor who doesn’t want you to get a second opinion is a doctor you shouldn’t be seeing.”

Taking your time to weigh these options once you know them is extremely important; you should not feel rushed into surgery if it’s not an emergency. Brownlee suggests questions to ask your doctor before embarking on a major procedure: What happens if I don’t get treated? What are the chances this treatment will work for me? How will this affect my quality of life? And in general, a doctor’s outright dismissal of your concerns without an explanation should be a red flag. 

For more tips, listen to the full piece on NPR.

The post Managing your health care in the face of a serious illness appeared first on Lown Institute.

A step in the right direction

We’ve written many times about efforts to switch from fee-for-service payments to value-based payments. Paying doctors based on patient outcomes rather than per service provided would ostensibly reward doctors for doing better rather than doing more. CMMI should be commended for creating more value-based payment models that can help keep patients healthier and reduce overuse. 

One way primary care doctors can increase patient engagement and keep their patients healthier is by meeting patients where they are. Patients may have trouble accessing their primary care clinician, if their only option is to meet them during weekday office hours. This can drive patients to urgent care clinics or even the emergency department, where prices are much steeper and the clinicians have little opportunity to develop long-term relationships with patients. 

As Dr. Victor Montori and others have pointed out, expecting patients to travel to the doctor for each appointment can put a significant burden on patients if they have to take time off work or secure child care for multiple visits. Having primary clinicians available for phone or video consultations outside of daytime and weekday hours has the potential to improve doctor-patient relationships. Paying doctors for virtual visits rewards doctors that already make themselves available, and provides an incentive for other doctors to follow their lead.

Key questions CMMI should address

While this new payment model has the potential for benefit, there are reasons to be skeptical. Previous value-based payment models have hit numerous obstacles, such as exacerbating providers’ administrative burden and punishing providers that serve higher-risk populations. 

Before we embrace the CMMI model, there are some key questions that need answering:

Will the reimbursements for primary care doctors make the program worth their time? Primary care doctors are under an increasing administrative burden. Some doctors may want to be available for patients after office hours, but find themselves already out of time and energy. Any new model expecting primary care doctors to dedicate more of their time to patients should make sure they are reimbursed enough so they do not have to take on more patients than they can successfully manage.

Many doctors find current incentive programs too burdensome already. “The requirements of the Maryland PCP program are so onerous that most practices (including mine) have to hire extra staff just to manage it, to rigidly follow the program rules (which are ill-defined) or risk losing much of the incentive money, and to have incessant meetings and generate copious reports every week,” said Andy Lazris, a primary care doctor in Columbia, MD. 

Another crucial problem with paying doctors based on patient outcomes is that, without accurate risk adjustment, doctors who care for high-risk patients will be penalized. If the program is revenue-neutral, this makes it even more likely that small practices with poorer and sicker patients will be penalized, because some doctors would have to lose money, and larger practices often have more resources and healthier patients. Clinicians should be assured that they will not be risking their financial health just because they see more low-income patients or patients with more chronic conditions.

Building a successful program

What would a successful primary care incentive program look like? Lazris has a vision for a program that could truly improve comprehensive care. First, the program has to commit to investing money in primary care (not be revenue neutral) with the goal of increasing primary care provider pay. Second, the program should avoid unproven quality indicators, excessive regulations, or difficult rules. Third, the program should give practices flexibility to provide care outside of the office in the way that doctors deem best for their patients, not just in ways mandated by the program.

Overall, a successful program would be based more around the Direct Primary Care model, where doctors are paid a monthly fee directly by patients instead of being paid fee-for-service by insurers. Because providers are not paid to see patients in person, they can rely more on telemedicine for patients when they are healthy, while giving other patients home visits and longer office visits when necessary. However, it will be difficult for CMMI to replicate this success if they do not invest the necessary resources in primary care.

“Unless the primary care provider can determine how best to care for patients and is given the power and money to do this, this program, like so many others like it, will fizzle very quickly,” says Lazris.

The post Can telehealth improve value in primary care? appeared first on Lown Institute.

No, the real problem in health care is that there isn’t enough technology involved, say the founders of Forward, a health care startup that just opened its newest clinics on the east coast. In a recent video on Cheddar  (a business, tech, and culture news site), Forward CEO Adrian Aoun explains why their model represents the “future of healthcare.” In the video, Aoun shows off the “tons and tons of technology” at Forward’s newest clinic, including heart scanners, body scanners, skin scanners, and DNA sequencing – all of which “give us a better insight to what’s going on with your body,” he says. The video sparked an interesting twitter conversation between investors excited about the expansion of Forward and doctors who were more wary.  

The hope for high-tech scans and DNA tests for primary care is that we will be able to get to know our bodies better and prevent illnesses before they start. However, as we wrote in a previous blog about Lab 100, these tests are as likely to expose people to overtreatment as they are to prevent illness. Here’s why:

Our tests are still not that accurate

If we all get regular heart scans, skin scans, and tests of every other body part, there’s no way we would miss any abnormalities, right? Unfortunately, for low-risk people without symptoms, getting tests like electrocardiographs, mammograms, cardiac stress tests, and many others are more likely to cause harm than good. If all of our tests were 100% accurate, they would be great to determine whether or not people have certain conditions, but they are not completely accurate. Even with 90% accuracy, these tests generate large numbers of false positives and expose many people to overtreatment. 

For example, screening low-risk adults for atrial fibrillation would require 10,000 people screened to prevent one stroke, but 800 of those people would get a false positive result (If Afib is present in 2% of patients, then 8000 do not have Afib, and 10% of these get a false positive result). And there is no clinical evidence that shows that treating asymptomatic Afib with anticoagulants improves outcomes for these patients.

Both doctors and patients overestimate the accuracy of tests and screenings, which often lead to false positives, overmedication, additional testing, and other unnecessary treatments, not to mention stress and additional financial costs. (For more on how many of the tests doctors do “just to be safe” end up creating more problems for patients, read Dr. Dan Morgan’s brilliant Washington Post op-ed about the harm of unnecessary tests.)

Tech industry to medicine: WE WILL GENERATE ALL THE DATA! YAY!!

Docs: What do I even do with this?

— Christina Farr (@chrissyfarr) November 14, 2018

 

DNA sequencing has no proven benefit

The idea of fully understanding our bodies by looking at every gene in our DNA is very tempting. Genetic testing can tell us our risk factors for certain diseases and atypical responses to certain medications, which sounds great. But in practice, genetic testing in primary care has not been shown to benefit patients. In a randomized controlled trial published in the Annals of Internal Medicine last year, patients that had whole genomic sequencing compared to just a family history did not result in any new findings or changes in medication management. And the physicians participating in this trial received several hours of training in genomic medicine, so they were more knowledgable than most doctors.

Why wouldn’t genomic sequencing help patients? Because knowing one’s risk of a disease is unlikely to change your current treatment or behavior. For example, if a patient shows an elevated risk of heart disease in their DNA, a doctor would likely tell them to eat a healthy diet and get regular exercise, advice that could be given to every patient. Knowing your risk for certain diseases might even increase stress, especially for diseases like Alzheimer’s for which there is no effective treatment yet. And though some say that knowing one’s risk of future disease is a powerful motivator for changing one’s lifestyle, this isn’t actually born out in studies of people who get tested.

Listening is critical to diagnosis

In the Cheddar video, Aoun belittles the conventional history-taking process, saying, “Today you go to a doctor, you sit there and tell them stuff and they almost ‘divine’ the answer…like a modern fortune teller.” What Aoun misses is that taking a detailed history and letting the patient explain their concerns is one of the most important things doctors can do to understand what’s going on with the patient. 

As Dr. Stephen Martin, associate professor of Family Medicine and Community Health at the University of Massachusetts Medical School, explained in previous interview about diagnosis: 

“Listening to patients is where we learn a great deal about the arc of the symptoms they’re having, the context and severity of the symptoms, what patients are concerned about and why. You can notice and examine symptoms like rashes, ask detailed questions about where patients traveled recently, ask them about other potential stressors in their lives. A CT scan doesn’t have the answers to these questions.”

Also, a patient’s health depends on much more than their physical state, according to Dr. Joachim Sturmberg, associate professor of General Practice at Newcastle University in Australia. Physicians often have to understand a patient’s mental, emotional, and social experiences to put their physical symptoms in context.

What Forward gets right

Aoun isn’t wrong that health care needs a drastic overhaul. In a recent profile in Business Insider, Aoun argues that it’s not just tech but preventive care that’s missing from the health care system. It’s true that our health care system is much more focused on treating ailments than preventing what causes them. However, the prevention part goes beyond “catching diseases early,” it’s about giving people access to the basic building blocks of health — fresh food, stable housing and income, and freedom from toxic stress. Our country’s poor investment in social determinants of health cannot be solved with more scanners. 

Our country’s poor investment in social determinants of health cannot be solved with more scanners. 

That’s not to say that the Forward model is all bad. People are increasingly craving a more simple way to engage with the health care system and get more time with their clinicians. The membership model of Forward and other “concierge” clinics provides easy access to clinicians and plenty of time to talk with them, which is very valuable. However, this can also be accomplished more affordably, as advocates of Direct Primary Care have shown. The leaders of Forward likely assume that they can charge more for giving patients more shiny technology, but it’s doubtful this extra “benefit” is even a benefit at all.

If the leaders of Forward want to change the future of medicine for the better, they could establish neighborhood primary care clinics, invest in social determinants of health, or make a better electronic health record (please!). More of the same tech in primary care is not the answer.

The post Another futuristic health care startup ignores overuse appeared first on Lown Institute.

In a two-part blog series in Health Affairs, Lown Senior Vice President Shannon Brownlee, internist Dr. Andy Lazris, and chairman of the Department of Family Medicine at Jamaica Hospital Medical Center Dr. Alan Roth, lay out the reasons behind these major issues and a blueprint to start fixing them (Read Part 1 and Part 2 on the Health Affairs website). The shortage of primary care clinicians can be attributed to many things – low number of residency slots, the salary gap between primary care doctors and specialists, high rates of student debt pushing trainees into higher-paying specialties.

However, the authors suspect another important reason fewer doctors are choosing primary care is that students see how primary care clinicians often have to work harder with fewer resources than specialists:

“Medical students also avoid primary care after watching primary care physicians struggle with short patient visits, large patient panels, increasing administrative burdens imposed by electronic medical record keeping and quality metrics, and significant night call responsibilities, all of which are disproportionate to the burden on specialists.”

New payment models that promote “value over volume” sound promising, but unfortunately have made things worse for many primary care clinicians, the authors write. Primary care clinicians are rewarded for jumping through administrative hoops and demonstrating they have achieved certain quality measures, while their pay decreases if they don’t fulfill the new measures. Many of these quality measures have not been validated, are not supported by evidence, do not benefit patients, and can even lead to overuse; in other words, they “serve mostly to distract from patient care.”

“Regardless of the inevitable resistance, the time to act is now”

Brownlee, Roth, and Lazris suggest several solutions for solving our primary care clinician shortage:

• Reduce the salary disparity between PCPs and specialists by replacing the specialist-run RUC with a truly representative advisory committee to determine physician fees 
• Have the government cover the cost of medical school for students who devote ten years or more to primary care
• Provide more CMS residency subsidies to primary care fields
• Encourage direct primary care models
• Create “Primary Care Trusts” that provide state-based universal coverage for primary care

These policies may not be politically easy to implement. As the authors write, some of them will certainly anger training hospitals and specialty societies. But the authors are not backing down. “Regardless of the inevitable resistance, the time to act is now,” they write.

Read the full blogs for more on the primary care shortage and detailed policy solutions!

The post Why we have a primary care crisis – and how we solve it appeared first on Lown Institute.

Where you train is where you practice

According to Dr. Vikas Saini, president of the Lown Institute, the physician shortage has a lot to do with medical education and training infrastructure. “Our training systems are biased towards cities and big urban centers,” said Saini, quoted in 24/7 Wall Street. Urban areas have larger populations with generally higher education rates, making it easier to attract medical students and trainees. 

That’s crucial because “where people train tend to be where people practice,” Saini said. 

Salary and lifestyle considerations also play a large role in determining where doctors practice. Residents of rural counties are generally older, lower-income, and in worse health than people who live in urban areas. Therefore doctors in rural areas are more likely to be reimbursed through Medicare or Medicaid, which pays less than private insurance, and could be punished financially for having a sicker and poorer patient pool. Also, counties that have difficulty attracting residents have difficulty bringing in doctors, many of whom are young and may be looking for a more fast-paced lifestyle.

Not just a rural problem

Although the doctor shortage is most acute in rural areas, the effects of this shortage ripple throughout the country. A rapidly aging population, coupled with high costs to entry for medical school and increased barriers to immigration for foreign-born doctors, means that we will soon face a shortage of doctors everywhere; rural counties are just the canary in the coal mine. 

“The doctor shortage is the tip of a broader iceberg,” said Saini, in an Atlanta Journal-Constitution piece about the physician shortage in rural Georgia. Having fewer doctors in rural areas also puts a strain on urban health centers. “When people who don’t have good access to care come to the cities for health care, they’re sicker, they come there later, and their use of resources is higher,” said Saini.

How to address the shortage

There have been some promising initiatives to bring needed health care to rural areas. In Webster County, GA, some health providers drive patients twenty miles to their appointments, or deliver medication to patient’s homes. 

In rural Maine, Dr. John Lowery and Dr. John Gunel of Central Maine Medical Center Family Medicine Residency conduct home visits to bring primary care to where patients are.

“With home visits we can see and treat the whole family at once,” says Lowery, in an interview with the Lown Institute, “We also eliminate no-shows and can get over potential language barriers by having an interpreter in person.”

However, these are difficult to implement at scale, and don’t solve the underlying issue of not enough health providers. Doctors who practiced in underserved areas need to be better compensated for their work, not punished financially with lower reimbursements. One way to do that would be having Medicare and Medicaid base their risk adjustments not only on medical risk but measures of social risk, such as disability, poverty, and homelessness.

Another way would be to offer more incentives to young doctors to practice in rural areas, or for underserved populations. New York University Medical School also made waves with their announcement to eliminate tuition costs for medical students, but as Elisabeth Rosenthal writes in The New York Times, this policy could have been better targeted to encourage doctors to fill in the gaps in care to reduce these inequalities.

The post What’s driving America’s rural doctor shortage? appeared first on Lown Institute.

These doctors have adopted a model of “direct primary care,” (DPC) in which their patients pay a flat, affordable membership fee every month instead of paying fee-for-service through insurance companies. Adopters of DPC say that this model allows them to focus on relationships with patients without administrative hurdles.

We spoke with Dr. Ryan Neuhofel, President of the Direct Primary Care Alliance, about how he got involved with the movement, and some of the benefits and challenges of growing the direct primary care movement.

Lown Institute: How did you first get involved with direct primary care?

Dr. Ryan Neuhofel: I was an early adopter of the DPC model. As early as the end of medical school, I recognized that the health care system was really screwed up, both for clinicians and patients. I knew I wanted to practice primary care at an independent, community-based clinic with a broad group of patients, but I didn’t see a primary care model that would allow me to do that.

I had read about a couple of doctors who had created their own direct primary care practices so I decided to just go for it. Back in 2011, there wasn’t a blueprint to follow for a DPC practice so I was somewhat starting from scratch, and making it up as I went along. All of us early adopters had a similar philosophy that we wanted to focus more on relationships rather than transactions, so charging a monthly fee instead of fee-for-service just made sense.

Lown: What makes DPC different from other models of care?

Dr. Neuhofel: DPC is transparent in every way. Patients know exactly what they’re paying, and what they’re getting. And as a doctor, I feel like I’m working directly for my patients. I can refocus on the person sitting in front of me.

The magic of DPC is time. We set aside 30-60 minutes for every appointment, and we can give every patient same-day or next-day appointments. People think this is too good to be true, which is kind of sad. But there’s only so much you can do in 10-15 minutes with the patient. If they don’t have the time to sit down and talk with the patient, you’re going to have to refer them, get tests, etc. If you really believe in the power of relationship with the patient, I don’t see how that’s possible in 10-15 minutes.

I think so many patients have felt disenfranchised and let down by the medical system. Too often, they have been screwed over financially, and not heard. If you can sit down for 30-45 minutes, it makes a huge difference. The patient feels listened to, empowered.

Lown: How do you coordinate care without using the standard electronic medical records (EMRs)?

Dr. Neuhofel: I find that records in our practice are actually more clinically relevant – they’re clean and compact, and use real language instead of just billing language. Patients can understand the notes because they’re written in a narrative. And we don’t have to worry about checking all the boxes on the EMR because we’re not billing an insurer for anything.

The flexibility of the DPC model also allows for innovative forms of communication. About half of my care is done remotely, through text messages, phone calls, and emails, because often patients just need to get an answer to a question. We can be there for the patients whenever they need us. Some may call this “telemedicine,” but in DPC it’s just part of how we communicate with our patients.

Lown: How is this practice sustainable when the cost of health care is so high? How can a small monthly fee cover it?

Dr. Neuhofel: It’s actually quite easy because we don’t live in that world of price inflation. If anything, we’ve seen prices go down. A lot of price inflation is from administrative costs and we don’t have that bloat. We also do wholesale, generic prices for medications, which are ridiculously cheap. Same with radiology services, which are actually affordable when you get the service directly instead of going through middlemen.

Not contracting with insurance companies can allow us to serve people who are uninsured or underinsured. For example, sometimes we give people “hardship credits,” or let them pay us later if we know they’re going through a rough patch financially. If you accept Medicare patients, you aren’t allowed to charge anyone less than Medicare, so we would not be able to do that.

Lown: There’s been a lot of news about “concierge medicine,” which also charges patients a flat fee for service. What’s the difference between DPC and concierge?

Dr. Neuhofel: DPC and concierge medicine are often conflated but they’re very different in many respects. Both models are attempting to offer their patients excellent service— good access, longer visit times, remote communications, house calls, etc.— but differ in how we achieve that level of care.

Other than price variation, they are fundamentally different business models. Most often, concierge doctors charge an expensive annual retainer fee in addition to billing patients’ insurance plans in a customary fashion; patients being responsible for copays and deductibles just the same. With DPC model, our lower monthly fees, $40-100/month on average, are covering actual medical services such as office visits, many ancillary tests, and procedures without any additional fees or billing— similar to a gym membership or Netflix. 

From a clinical perspective, the difference I see is that DPC tends to be a more slow, conservative approach to medicine, rather than trying to upsell people on extra tests and “executive” level services.

In the trenches, I also see that concierge practices are usually serving a different patient population that most DPC practices. My patients are far from a wealthy, country club crowd associated with concierge. Most of them are low to moderate incomes, and uninsured or with high deductibles; often people who are falling through the cracks of our broken system. I joke that I run a “concierge safety-net” clinic! I think this is true of most DPC practices.  

Lown: What is the Direct Primary Care Alliance and what are you working on right now?

Dr. Neuhofel: The DPCA is a grassroots group of doctors who are using the DPC model and trying to help others who are just getting started with DPC. Most of us are full-time physicians with really small practices. We’re trying to help other doctors learn what we do and do it right. We provide resources, education, and some advocacy.

The DPCA is non-partisan and many of us share differing political views. Most people are just trying to grow their practice, not do advocacy work. But in many ways, starting a DPC practice is an act of activism. The DPC model shines a light on everything that’s not flattering about the health care system – administrative red tape, markups on drugs and radiology, etc. We’re just as fed up with all of the crap as anyone else.

The post The direct primary care revolution appeared first on Lown Institute.

“Street Nursing” in Philadelphia

Dr. Beth Ann Swan and Dr. Kathryn Shaffer, professors at the Jefferson College of Nursing in Philadelphia, are excited to bring their model of community-based care to the Lown Conference. Working within a large hospital system, Swan and Shaffer knew they needed a better way to address the unique health concerns in each local branch.

They developed a pilot program called “Caring for Frankford,” where nurses bring care to members of the Frankford neighborhood of Philadelphia by partnering with local churches, schools, shelters, and other community centers. This initiative, which Swan and Shaffer call “street nursing,” utilizes a new educational curriculum for providers, community engagement methods, and assessment of community health needs.

“We want people to leave knowing that they can implement this model in their city,” says Swan,”You don’t need massive amounts of money to help communities. It’s about thinking small and working your way up.”

Bringing back home visits in Maine

Home visits haven’t been a common part of medical practice in the US since the mid-1900s. But Dr. John Lowery and Dr. John Gunel of Central Maine Medical Center Family Medicine Residency are trying to bring them back. It may seem time-consuming for doctors to travel to patients’ homes, but Lowery and Gunel find that doing home visits is efficient and provides better care for patients.

“With home visits we can see and treat the whole family at once,” says Lowery, “We also eliminate no-shows and can get over potential language barriers by having an interpreter in person.” The CMMC model does not require a large amount of resources because they send three staff members to each home, and patients are pre-registered. Home visits can also be learning experiences for the residents and medical students who help provide care.

“Visiting homes is very meaningful to us, because it gives us insight into our patient’s home environment,” says Lowery. Bringing care to patients’ homes also helps doctors build trust with community members, making it more likely that they will come to the medical center when they have problems.

The post Meeting people where they are for primary care appeared first on Lown Institute.