Primary Care: The New King of the Schoolyard

It was a different story only five years ago.  For most medical students finishing their residencies and many in the medical profession, primary care as a medical field represented the ugly stepchild of the family and the last to picked in gym class.  The jocks and cheerleaders (e.i., cardiologists and radiologists) were looked up by everyone in the playground and were the kings/queens of the school.  And when compared to specialists, primary care physicians (PCPs) were in fact generally paid less and subject to working longer hours with many days filled with fevers and strep throat.  

However, that is dramatically changing in our post-reform environment.  With headlines like “recruitment demand high for primary care doctors” dotting newspapers and blogsphere, the field of primary care has emerged as the new “it” profession in medicine.  According to a 2010-2011 study by Merritt Hawkins, family practice and general internal medicine physicians were the top two most requested physician search assignments.  The former top dogs–radiologists, cardiologists, and anesthesiologists–dropped in search assignments to 17th, 18th, and 19th, respectively.  

This seemingly about-face has a lot to do with the new landscape in healthcare.  The recent healthcare legislation has put primary care at the center of tomorrow’s healthcare delivery system.  New reform initiatives like patient-centered medical homes and accountable care organizations will depend heavily on primary care to serve as a linchpin in the coordination of care.  This means that PCPs will be expected to play the principal role to manage the health of their patients, notably those with chronic health conditions.  Improved case management, coordination with specialists, and more time spent with each patient–considered to be fundamental components to lower costs and enhance quality for patients for our healthcare system–will be led by primary care physicians.   

At the same time, economic factors have played a role in primary care’s rise to the top.  Due to the economic downturn and increased pressure to cut spending, elective procedures and reimbursements cuts have significantly reduced the need to hire certain specialists.  Alternatively, primary physicians now at the epicenter of care are seen as a key component in a hospital’s strategy to integrate its services across the spectrum of care and remain financially competitive.  Case in point, by aligning with PCPs and certain specialities, hospitals can shore up their patient referral base and avoid leakage to other systems.  

Here in Atlanta, as the market continues to consolidate among major providers (Emory buys St. Joes, Piedmont buys Henry Medical, etc.), we’ll see even more of an appetite for primary care and pressure for all physicians to align with one hospital system.  (This is also a national trend where more than half of new doctors today are hired by hospitals, according to the Medical Group Management Association).  Long gone are the days of primary care being left dateless at the big dance.  Rather, you can bet that primary care will be the star quarterback everyone wants to be like for some time to come.  

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