Healthcare Must Expand Primary Care Models, Says Report
To strengthen and support primary care in the future, health leaders need to consider new ways to organize providers—including primary care physicians, nurse practitioners, and physician assistants—and to expand their roles in delivering care, according to new recommendations from a group of healthcare leaders convened by the Macy Foundation.
The diverse panel, which included allopathic and osteopathic physicians from academic and general practice settings, nursing professors, nurse practitioners, physician assistants, medical school deans, academic health center executives, and representatives from health policy, government, and business, suggested that nurse practitioners and physician assistants should obtain greater roles in delivering primary care.
As part of a reformed system of primary care, healthcare leadership needs to expand the workforce beyond the scope of physicians, said Joanne Pohl, PhD, professor at the University of Michigan School of Nursing in Ann Arbor. "To put it simply, there just aren't enough of us in the field doing all the work that needs to be done," she said at a telebriefing.
The panel agreed that this means removing state and federal regulatory barriers that make it difficult for nurse practitioners and physician assistants to fully participate as primary care providers and leaders of primary care teams, Pohl said.
"Removing regulatory barriers to practice makes sense, as many of the current regulations are outdated—dating back to 30 years ago when roles were new. They lack evidence to support them, they're often costly, and they actually limit access to primary care," Pohl said.
The lack of a strong primary care system in the U.S. has had consequences for access, quality, continuity, and cost of care, according to Victor Dzau, MD, president and CEO of the Duke University Health System in Durham, NC, and Chancellor for Health Affairs at Duke University.
To make changes, it will be important to "invest" in primary care. That includes improving the infrastructure by supporting the use of electronic health records, home care, and education.
Despite what goes on at the federal level, payment reform needs to be addressed as well. "This is s tricky issue," Dzau said. "How we do that [will be met with] a long debate, but I think the issue is to rebalance—not to take away but to balance at the appropriate level support." This could help providers feel more incentivized and rewarded "for what they do."
Other recommendations from the Macy Foundation panel are:
- Medical, nursing, and other health professions schools must educate students differently for careers in primary care. They should expose students early in their education to primary care, immerse them in community primary care practice settings, teach them to work in teams, and identify effective role models for them.
- Schools should strive to attract more students into primary care by establishing programs to diversify their student bodies socioeconomically, racially, and geographically
- Academic health centers should embrace new team based primary care systems as part of their mission; they must provide interprofessional leadership by developing and implementing effective delivery models for others to replicate.