Calling primary care "the cornerstone for all of California's health care delivery systems" and "the foundation for every goal of health care reform," a new organization arrives in California next week hoping to give the profession a shot in the arm.
The California Advanced Primary Care Institute brings together a wide spectrum of stakeholders with high hopes of reinvigorating a key part of the health care workforce in California. The state's primary care workforce will decline by about 30% over the next decade at the same time demand increases with millions of Californians gaining coverage through the Affordable Care Act.
As aging primary care physicians retire, fewer younger doctors are stepping up to take their place. Fewer medical school students have elected to pursue the primary care path, electing to pursue better-paying specialties. Primary care reinforcements are less than half of what they were 15 years ago, according to officials at the new institute.
The problem is not new, and other efforts have attempted to bolster the primary care ranks. However, this group expects to make progress where others have stalled.
"There may be good cause for optimism," said Dylan Roby, assistant professor of health policy and management at UCLA's Fielding School of Public Health.
"This could be a more cohesive group than others that have tried -- certainly it's more inclusive. It's very promising that it has so many stakeholders involved, including the medical group world," Roby said.
Institute has Physician Group Roots
The institute, an independent not-for-profit organization, has roots in the California Association of Physician Groups.
Elissa Maas, executive director of the new institute, said the seed was planted by Wells Shoemaker, chief medical officer of CAPG, and John Jenrette, CEO of Sharp Medical Group and chair of the CAPG executive committee.
"Those two started a dialogue in 2011 about the looming crisis in primary care and what could be done about it," Maas said. "They really were the visionaries, and next week is the coming out party for what they envisioned. We convene the leadership team on Tuesday for what amounts to the official launch," Maas said.
The institute's goals are to increase the appeal of primary care as a career choice and improve performance of primary care teams under health reform.
The institute's governance body includes insurers, nurses, employers, physicians and representatives from academia and the military.
Susan Hogeland, executive vice president of the California Academy of Family Physicians and a member of the institute's governance body, said the broad spectrum of participants is encouraging.
"There have certainly been some well-intentioned efforts in the past, but I don't know if there's been anything as broad-based as this with so many good people from so many diverse backgrounds. This group brings gravitas to the table. I couldn't be more pleased with the quality and variety of experience represented in this group," Hogeland said.
Hogeland said the institute's roots in CAPG will help the new entity steer an effective course.
"CAPG is a very metric-driven organization and in general has the capacity to measure progress and success. They get rich data, and I think that bodes well for the institute's ability to measure its own progress," Hogeland said.
Kevin Grumbach, chair of the UC-San Francisco Department of Family and Community Medicine and part of the institute's governance team, said including academia in the project is a key to effective change.
"If we are going to transform primary care to provide superb, patient-centered care to every Californian, we will need to fundamentally change our approach to training the people who work in primary care," Grumbach said.
"This new coalition represents an unprecedented partnership between practice organizations and training institutions to equip the workforce for the innovative care models that will drive excellence in primary care throughout California," Grumbach said in a prepared release.
Wide 'Scope of Engagement'
Institute officials said they plan an "ambitious scope of engagement" in four specific areas they call "the four Ps:"
- Pipeline. Change the training environment and the appeal of primary care as a career choice for physicians and other clinical professionals;
- Practice redesign. Practice with greater efficiency, better information, modern communication and central attention to the patient experience;
- Payment. Align primary care pay with its pivotal role in health care reform; and
- Policy. Institute officials will encourage lawmakers and policymakers to rethink decisions made in "a 60-year hodgepodge of assumptions, regulations and conventional wisdom that has landed the U.S. (and California) lower than 20th in the world in nearly every public health measure."
Lisa Folberg, vice president for medical and regulatory policy at the California Medical Association, said the third "P" is especially important.
"It's good to see payment in the mix," Folberg said. "I know folks don't always like to talk about the nitty gritty, but as students look at their medical school debt payment and balance that with how much they'd make as a primary care physician -- that's an important discussion and I'm glad this group is having it."