If I were a medical student today… Scott Eathorne, MD Medical Director Providence Medical Group Partner Health

Would I still go into Primary Care?  Then and now: the ’80’s and today  Idealism and Realism: “It’s not, or at least not initially, about the money”  Primary Care “Motherhood and Apple Pie” – The PCMH –Personal physician: PCP, selected specialists –Physician directed medical practice: team based care –Whole person orientation –Care that is coordinated and/or integrated: Wegner’s Chronic Care Model –Quality and safety –Enhanced Access: “the right care at the right time and place” –Payment

Then…  More care, less paperwork (although the HMO looming large…)  Be your own boss (but physician employment on the rise…)  Everyone provided outstanding care (no consistent performance reporting, certainly not public)  Demand for primary care (a buyer’s market – “Gatekeepers Needed”)  “Doctor knows best” patients  Reasonable pay

And now…  Mounting “paperwork” (referrals, prior authorizations, performance reporting)  Transitional payment chaos (FFS to Capitation to P4P)  Constant “transformation”: (Pursuing the PCMH)  Profiling and Performance Reporting (maybe my care isn’t outstanding)  Educated patients (sometimes demanding)  Declining volumes from lost coverage (but anticipated demand – The Aging Boomers)  Overall declining pay and the need to pursue other revenue streams

The Opportunity  Leadership in the evolving healthcare paradigm  From “Gatekeeper” to “Partner in Health”  From episodic care to population management  Equal parts art and science (Marcus Welby with a computer)  Demonstrated excellence and value  Creating Accountable Care Organizations – moving PCMH beyond PCP office to engage specialists, hospitals, and other care providers  Payment models that adequately reward the pivotal role of PCP

The Risks  Systemic adoption of PCMH does not occur (and promise of improved quality/safety at lower cost not realized) –Inability to effectively engage all care providers  Consumers don’t value the new care model (I want the care I want, when and where I want it)  Payment reform doesn’t occur in a meaningful way (continued incentives toward procedural work, episodic care)  Consumers aren’t engaged through benefit design to change

And the answer…  YES!  But what to tell the kids??  And who will take care of me??