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The Emerging Primary Care Workforce: Preliminary Observations From the Primary Care Team: Learning From Effective Ambulatory Practices Project

Ladden, Maryjoan D. PhD, RN; Bodenheimer, Thomas MD; Fishman, Nancy W. MPH; Flinter, Margaret PhD, RN; Hsu, Clarissa PhD; Parchman, Michael MD, MPH; Wagner, Edward H. MD, MPH

doi: 10.1097/ACM.0000000000000027
Perspectives

Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors’ preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012–2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation–funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.

Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.

An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team.

Dr. Ladden is senior program officer, Robert Wood Johnson Foundation, Princeton, New Jersey.

Dr. Bodenheimer is adjunct professor, Department of Family and Community Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

Ms. Fishman is interim team director and senior program officer, Robert Wood Johnson Foundation, Princeton, New Jersey.

Dr. Flinter is senior vice president and clinical director, CHC, Inc., Middletown, Connecticut.

Dr. Hsu is research associate IV, Center for Community Health and Evaluation, Group Health Research Institute, Seattle, Washington.

Dr. Parchman is director, MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, Washington.

Dr. Wagner is director emeritus, MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, Washington.

Funding/Support: The RWJF provided funding support for the LEAP project.

Other disclosures: None.

Ethical approval: The Group Health Research Institute institutional review board reviewed the LEAP project and classified it as exempt.

Correspondence should be addressed to Dr. Ladden, Robert Wood Johnson Foundation, Route 1 & College Road East, PO Box 2316, Princeton, NJ 08543; telephone: (609) 627–6157; email: mladden@rwjf.org.

© 2013 by the Association of American Medical Colleges