University of Utah Health Care's Community Clinics are receiving national attention for developing "Care By Design," one of the first models in the country to integrate acute, chronic and preventive care into a comprehensive system for treating patients.
What are some misconceptions and how does it work? Scott Shipman, director of Primary Care Affairs and Workforce Analysis for the AAMC interviews Michael K. Magil, M.D., chair of the Department of Family and Preventive Medicine at the University of Utah.
Shipman: A lot of people hope that as teams are employed in the primary care setting that it will enable primary care physicians to manage larger patient panels.
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Shipman: I am Scott Shipman, the Director of Primary Care Affairs and Workforce Analysis at the Association of American Medical Colleges.
Magill: I'm Mike Magill. I'm the Chairman of the Department of Family and Preventative Medicine at the University of Utah. Scott, you're really focused on workforce issues on behalf of the AAMC. What's the challenge in workforce now in a time where academic health centers are having to be very invested in transition to a new model of care?
Shipman: I think that the major issues going forward with the workforce is simply moving to a new era where there are a lot more question marks than answers and we anticipate that there will be significant changes in workforce need in the skillset of physicians in the future. But exactly how today's or tomorrow's health care delivery models influence the need for positions and the number of positions and their skills remains to be seen.
Magill: How are academic medical centers doing in transitioning their delivery systems into teams and in transitioning education into teams?
Shipman: We are seeing a groundswell of recognition of the importance of inter-professional education in academic medicine and across multiple professions and disciplines. The actual delivery model to support and reinforce the didactic education in professional teams is lagging behind to some degree. There are exceptions to that rule that there are centers like your own where team-based care is really well developed and really exemplary. A lot of the country, though, is still struggling with the reality that while they'd like to have team-based care models in primary care and elsewhere to expose their learners in the clinical arena, there's a paucity of those teams in practice to really expose them.
Magill: So I know that one of the things that you've been looking at is changing delivery systems and the implications for education and particularly in primary care. There's kind of a dilemma as to whether we're going to see larger panels per doctor, smaller panels per doctor, how the teams are going to influence that. How do you think this is playing out?
Shipman: A lot of people hope that as teams are employed in the primary care setting that it will enable primary care physicians to manage larger patient panels. What I think we're seeing in the examples that we've gone out and looked at, more than that is actually the ability for primary care practices with a team in place to provide more comprehensive services to the patient population it has and that expanded scope of services to really aim to fulfill the primary care mission is soaking up a lot of the extra capacity that the team might otherwise provide.