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A Primary Care Vision From Family Physicians: A Response To A Health Policy Brief



December 5th, 2012

Editor’s note: The post below was written in response to Nurse Practitioners And Primary Care, a Health Policy Brief recently published by Health Affairs and the Robert Wood Johnson Foundation.

The American Academy of Family Physicians welcomes discussions about primary care as foundational to a true health care system. Approaches must be multi-faceted and team-based at every level. Changes must be made in education, training, health care access and provision, and payment. Solutions focusing mainly on cutting costs or shortcutting training are short-sighted.

Physicians and advanced practice nurses are not interchangeable. Each has roles defined by training and experience. The best quality patient care depends on these critical members functioning efficiently in teams.

Every American needs and deserves a personal physician and nurse. The educational and training differences are profound: advanced practice nurses follow different paths to their degree, completing 2,300 – 5,350 hours of education and clinical training during five to seven years, compared to family physicians’ standardized path of 21,700 hours and 11 years. Family physicians’ additional training brings breadth and depth to the diagnosis and treatment of all health problems, as well as hands-on knowledge of other disciplines, improving coordination of care within systems.

The primary care shortage will grow as more Americans gain insurance coverage under the Affordable Care Act. The answer is not to substitute one team member for another, but to have more doctors and more nurses working together in integrated, coordinated, physician-led health care teams in patient-centered medical homes. This model has proven to increase the quality of care for the patient and cost-effectiveness for the health care system, and it closes the workforce gap.

Family physicians value nurse practitioners. We work with these skilled teammates across the country. We share our vision in our report Primary Care for the 21st Century, which offers a greater perspective on this important issue.

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2 Responses to “A Primary Care Vision From Family Physicians: A Response To A Health Policy Brief”

  1. Robert Bowman Says:

    Acting for a Future for Family Medicine

    Family medicine, US primary care, and most Americans left behind in basic health access all need the same thing – more family physicians. In every important parameter, FM does it 3 to 6 times better. In some areas such as instate primary care where needed, FM can be a 12 times better solution. For 30 years the US designs for health policy and for medical education have neglected most Americans, US primary care, and family medicine. Health access has worsened and family medicine remains at 3000 annual graduates as in 1980.

    Flexible primary care solutions dominate discussions rather than the sole remaining permanent strong solution – FM. Insurance foundations, institutions, and others with agendas promote their weak solutions while family physicians deliver the real deal for their entire careers. Flexible fails and permanent persists.

    Flexible workforce has followed US health spending designs away from primary care (even when training in PC) and away from where needed to top health spending per capita zip codes. Only family practice remains, and only when remaining in family practice as in over 95% of FM and less than 25% of NP or PA graduates.

    The solution for most Americans, primary care, and FM is an increase in FM graduates. FM specific preparation and training specific to FM should be added to insure the best input to FM residencies. More years of FM GME is the wrong way for a specialty with a lifetime of learning to go long after residency.

    More years of FM specific training before, during, and after training is the real future of FM. About 11,000 annual FM graduates from FM schools would solve primary care and health access woes. We cannot allow distraction from action.

    Real solutions are those that stay in primary care in reality. Stop innovation and reorganization focus and apologetics. Real solutions past, present, and future are more for FM. See AAFP Linked in Managers Choice

  2. www.acadigest.org Says:

    Agreed, but I am afraid that unless the professions and the political world make, preventive care, wellness and non-pharmaceuticaal, non-operative care the primary focus of their integrated, patient centered medical homes the health care system will indeed be overwhelmed and will become too costly for any private or public budget to support.

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