But that’s changing—and Children’s Hospital Boston is leading the way. The primary care departments of Children’s, Children’s Hospital Primary Care Center (CHPCC) and Martha Eliot Health Center (MEHC), have been chosen by Harvard Medical School to take part in its Center for Primary Care’s Academic Innovation Collaborative. They have been awarded $900,000 over two years, to be matched by the hospital, to work with the Collaborative to transform primary care delivery and education.
The Collaborative is providing more than $5 million in grants, all of which are being matched, to nine Harvard Medical School affiliated hospital-based primary care teaching practices and eight affiliated community health practice partners to innovate in four key areas: team-based primary care, management and prevention of chronic illnesses, management of patients with multiple illnesses, and patient empowerment and behavioral change.
“A partnership of this scope is without precedent in our community and could provide solutions to our country’s most pressing health care problems—solutions that we hope will make our state health care system, and ultimately our national health care system, among the best in the world,” says Center for Primary Care Interim Co-Director Russell Phillips, MD.
That’s the thing: Over the past several years, it has become clear to the rest of the health care world what we primary care providers have known all along: we are not only central to the care of patients, but to any effort to improve the quality and cost of health care. We are the ones who are on the front lines, the ones who see the patients first and continuously. We do the preventive care that keeps people healthy and cuts costs. We do the referrals to specialists and coordinate care so that the specialists are effective. We follow and monitor patients—oh, and yeah, we take care of their mental health and social needs too.
Which is why it has always felt unfair that we are the Rodney Dangerfields of medicine. Primary care is hard. It’s a big job, with many tasks, and you need to know at least a little about every aspect of medicine in order to make the right diagnosis, the right referral, the right treatment plan. It’s a fascinating, challenging and rewarding job, but it is hard and getting harder, with demands to not only see more patients but do more with them when we see them. There are times when it feels downright impossible. And the fact that primary care doctors make about half as much as specialists doesn’t help either, especially when the average doctor finishes medical school with about $200,000 of debt.
This helps explain why there is a nationwide shortage of primary care doctors. Although more medical students are entering primary care—according to the Association of American Medical Colleges, the number of medical students matching into primary care residencies went up 20 percent between 2009 and 2011—it’s estimated that we are still short about 30,000 primary care doctors here in the United States.
It has become increasingly clear that the academic medical centers need to take a central role in recruiting new primary care doctors and in strengthening and improving primary care delivery. In that spirit, Harvard Medical School launched its Center for Primary Care in October of 2010. “It is wonderful that Harvard Medical School has decided that primary care is really important, and that they want to invest their resources and reputation in promoting the development of the best primary care models,” says Joanne Cox, MD, director of CHPCC and the Principal Investigator of the Collaborative at Children’s. “And we are really grateful for the support of the hospital.”
Children’s has shown its commitment to primary care in other ways, such as by supporting the medical home initiative and working collaboratively with local primary care pediatricians. As any family can tell you, health care works better when everyone has a regular primary care doctor—and when that primary care doctor has the resources and support he or she needs.
Cox is busy working with her team to put their ideas into action. “It’s an exciting time to be in primary care,” she says. “I am really hopeful for our future.”