Primary care: Gatekeepers to good health increasingly important


The world of primary care is changing, and not just because people across the country have signed up for health insurance through the federal Affordable Care Act.

Other forces for change include a shift to a team-based approach to medicine, a shortage of primary care doctors, and the need to guide patients through the increasingly complex medical world.

"The family doctor is a partner with each person they serve, a quarterback for that person's health care," says Dr. David Lynch, a board member of the Washington Academy of Family Physicians and former medical director at Family Care Network, an independent, physician-owned practice in Whatcom County.

Family Care Network is one of 30 providers in the country being studied by the Robert Wood Johnson Foundation of Princeton, N.J., to identify and promote cutting-edge practices in primary care. A key reason for such studies is the Affordable Care Act. As more people gain medical coverage, the flood of new patients could create a logjam if the health care system - primary care included - doesn't become more efficient.

Larry Thompson, executive director of the Whatcom Alliance for Healthcare Access, says health care has been fragmented, with poor coordination between facilities and care providers. To improve the system, primary care doctors and their staffs will play an increasingly important role as front-end coordinators, he says.

In Whatcom County, members of the medical community have agreed to pursue what's called "medical homes" to improve treatment, he says. Medical homes is the term for primary care practices that focus on actively managing the care of patients, rather than merely wait for patients to call for appointments.

For example, a medical home would track a doctor's diabetic patients and bring them into the office whenever problems arise. Such an approach for people with long-term ailments is especially crucial because more than 75 percent of health care costs in the U.S. is due to chronic conditions, according to the Centers for Disease Control and Prevention.

Thompson says some medical practitioners in the county are well on their way to the medical home approach, while others are just beginning the journey.

Under the team approach, staff members other than physicians can carry the load monitoring and contacting patients and handling an array of other related tasks, says Karen Sharpe, medical director for primary care at PeaceHealth Medical Group, with some 800 physicians in Oregon, Alaska and Washington, including Bellingham.

"We're hiring nurse practitioners, RNs and other staff members to work registries and bring patients in when they need care," says Sharpe, who works in Vancouver, Wash. "We're expanding the team to allow the physicians to do what they do best, which is diagnose and deliver the care."

Sharing the workload should help primary care providers better cope with the expected increase in patients due to expanded health insurance and to the overall graying of the general population.

It also should help them cope with a tight supply of primary care doctors, the result of at least two factors, Sharpe says. Many doctors are baby boomers who are nearing retirement; at the same time medical school students have gone heavily into specialized care rather than family care because specialists are paid more money.

The shortage of primary care doctors makes the recruitment of new physicians even more important. Whatcom County's scenic beauty is a plus in that effort.

"In Bellingham we're relatively successful in recruiting because doctors like to move to the area," Thompson says. "But we're still going to have to make changes in the way care is organized to meet the demand."

At Family Care Network, letting doctors focus on treating patients is one of the network's selling points when talking to prospective new physicians, Lynch says.

"We've tried to organize our practice around supporting our physicians so that they're free to practice medicine, do what they think is best for their patient, and be in a practice where they can still be an owner and a decision maker," he says.

Lauren Kramer is a Bellingham freelance writer. Read her work online at

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