To the Editor:
The lack of primary care physicians is a major concern. Only a major makeover of primary care training and primary care physicians’ status can address it.
The training part of the makeover can take place if patient-centered medical homes (PCMHs) are more widely developed. To optimize the care delivered by PCMHs, primary care physicians must have training in (1) the team management of chronic disease states and acute illnesses, (2) coordinating and integrating care provided by subspecialists, hospitals, skilled nursing facilities, home care, nursing homes, and community health agencies, (3) optimizing communication, including the use of advanced electronic technology, (4) managing behavioral health issues and end-of-life concerns, (5) maximizing population health with an understanding of preventive health, epidemiology, and biostatistics, (6) business management and medical economics, (7) advanced leadership skills, and (8) team building, which can be fostered through interprofessional educational programming. It is a daunting task to effectively train physicians in mastering the above subject areas, but various innovative primary care training programs have commenced many of these educational initiatives.1,2
Once correctly trained, these primary care physicians will possess a unique and advanced professional skill set, with expertise not existing generally among physicians today. Hence, we believe future primary care physicians should truly be elevated to specialty status in the eyes of the medical community. This elevation will require “rebranding” to remove negative connotations surrounding this professional group of physicians. Promotional ad campaigns and extensive insurance company lobbying will help along these lines. It is unquestionable that innovatively trained primary care physicians have the potential to positively influence the practice of medicine for decades to come. In addition, with this “makeover,” we suggest that the next-generation primary care physicians be referred to as primaryists—physicians specializing in a team approach to health care delivery that stresses the critical importance of the care continuum and population health.
Also, it follows that primaryists’ professional compensation be increased commensurate with their specialty status.
By achieving increased stature in the medical community and greater compensation, hopefully a larger number of medical students will be attracted into career tracks serving as next-generation primary care providers.
David Michael Rosenberg, MD, MPH
Assistant clinical professor of medicine, Case Western Reserve School of Medicine, and medical director, Corporate Health, University Hospitals, Cleveland, Ohio; firstname.lastname@example.org.
Victor Vertes, MD
Emeritus professor of medicine, Case Western Reserve School of Medicine, and former chief of medicine, Mt. Sinai Medical Center, Cleveland, Ohio.
Josef Edelstein, MD
Former associate professor of medicine, Case Western Reserve School of Medicine, and former chief of cardiology, Mt. Sinai Medical Center, Cleveland, Ohio.
1. Carney PA, Green LA. An emerging epidemic of innovation in family medicine residencies. Fam Med. 2011;43:461–463