The Evolution of Primary Care 

By: Kathy Ruscitto

For many  years we have lived with the concept that primary care  is delivered by an office based physician who treats and coordinates all our care. The wisdom and experience primary care physicians have  brought to this practice has been remarkable. Over the last several years environmental pressures have brought about an evolution in the Primary Care model leading to  unique new access points for patients.

Covid added to an existing workforce shortage and many physicians faced burnout from growing demands . From 2005 to 2015 there was an 11% drop in primary care physicians.  Recent tracking suggests that decline has continued.

The result is the evolution of a broader model of primary care access ranging from Urgent Care, Retail Clinics to Online Telemedicine consults, and Paramedicine Pilots.

Heather Drake Bianchi, CEO of Drakos Dynamics, a provider of urgent care and family medicine in CNY underscores the importance of accessibility.  In a recent interview she emphasized the value of being available when patients need care , outside traditional office hours, aligning with the shifting demands of today’s workforce and lifestyle. 

Another essential change, is that many sub specialties are now seen as key or integral to the primary care provider. Integrated primary care considers the input from Pharmacy, Dental, Mental Health, Physical Therapy and Health coaching in an integrated record . These teams, often system based , believe primary care has to include a balanced view across all providers. The blending of all these perspectives across an integrated team allows for better delivery of care in a patient collaborative model.

Dr. Julie Colvin a busy Family Physician and Medical Director of Northeast Family Physicians at St. Joseph’s HHC states,

“Healthcare has to change and evolve, and those options will also give patients and providers more flexibility, and will help the healthcare workforce shortage. We want to make sure that the quality of care in those extended fields is the same as traditional medical care.”

These new access points are exploding using technology, remote access to physicians, and even algorithms that direct care based on AI analysis of patients’ answers to questions.

In many ways these new access points are part of an Integrated Primary Care model.  In order for that information to be readily available from any access point, it must be integrated across the medical record, or accessible to providers through the  Regional Health Information Organization.

It is not unusual for me to find younger patients using these new access points and not having a primary care physician. 

For specialty practices I pose the question, have you adjusted your outreach  approaches for patients  based on these new access points? 

The health care environment continues to evolve utilizing the opportunities from technology, and helping patients find the right care, at the right time, in the right setting.

Kruscitto 1/24

Krusct@gmail.com

Board member and advisor

Resources

Primary Care in the US, a brief history

https://www.ncbi.nlm.nih.gov/books/NBK571806/#:~:text=New%20models%20of%20care%2C%20such,of%20quality%2C%20and%20more%20formally

Primary Care: Past, Present and Future

https://www.medpagetoday.com/opinion/focusonpolicy/103811

https://www.sjhsyr.org/find-a-service-or-specialty/primary-care

https://www.drakosdynamics.com/

Can Paid Medical Experts Guarantee Justice in Medical Malpractice Cases? 

By Jennifer Negley

Expert witness testimony is essential to all medical malpractice legal proceedings. Usually, without a medical expert, plaintiffs cannot proceed to trial, and defendants are usually doomed to an adverse jury verdict. Medical experts are recruited in many ways, even from proprietary companies that offer a diverse variety of experts.

Finding these crucial experts varies from direct attorney contact to agencies offering a wide range of specialists. Though they’re key figures in court, their most important job is to be unbiased and help decide the case fairly. Professional organizations like the American Academy of Family Physicians have outlined stringent guidelines:

  • Unwavering Objectivity: Physicians serving as expert witnesses must hold themselves to the highest ethical standards, ensuring complete and unbiased information is presented. They are not advocates, but impartial guides illuminating the medical realities of the case.
  • Adherence to Standards: Their opinions should reflect the established benchmarks within their specialty, both at the time of the alleged incident and in the present. Thorough familiarization with the case and relevant medical standards is paramount.
  • Fair Compensation: Recognizing the significant time and effort involved, reasonable and commensurate compensation for expert witnesses is essential.

In this time of shrinking fees and increased costs, physicians are debating if they should offer their services as a paid medical expert. Many questions arise when considering this path. One prominent national insurance carrier has challenged this matter with a few questions that can be beneficial when evaluating this option. Among them are:

  • Schedule Balancing: Can you seamlessly integrate court appearances into your patient care schedule without compromising either?
  • Case Complexity: Are you prepared for potentially vast medical records, repeated attorney meetings, lengthy depositions, and extended court battles?
  • Pressure and Performance: How comfortable are you with verbal sparring and intense scrutiny in a courtroom setting?
  • Potential Repercussions: Could your testimony be used against you in the future?
  • Maintaining Expertise: Can you resist the pressure to stretch your opinions beyond your areas of expertise to better suit a particular side?

Many physicians may not realize that their existing professional liability policies don’t automatically cover them for acting as a paid expert witness. This presents a significant financial risk you shouldn’t ignore. To make an informed decision, consulting your insurance advisor is vital. They can clarify your existing coverage and guide you toward securing any additional protection necessary to enter the world of expert witness testimony.

While the role of medical experts in malpractice cases remains crucial, both plaintiffs and defendants should carefully consider the implications before engaging a physician for compensated testimony. It’s a path demanding specialized skills, significant time commitment, and ethical considerations, necessitating a thorough self-evaluation and consultation with one’s insurance advisor. Ultimately, ensuring responsible and unbiased expertise in the courtroom necessitates understanding the complexities and obligations involved for all parties concerned.

For more information on your insurance options, please contact Jenn Negley, Vice President, Risk Strategies Company at 267-251-2233 or JNegley@Risk-Strategies.com.

Rampant Burnout Among Healthcare Workers

by William Ecenbarger

There’s a new epidemic across America–burnout among healthcare workers. Although the initial focus had been on physicians and nurses, a new study found the burnout problem impacting the entire healthcare workforce–pharmacists, social workers, respiratory therapists, hospital security officers, and staff members of health care and public health organizations.

The results of a survey of more than 40,000 healthcare workers by the Harvard Medical School’s Brigham and Women’s Hospital was reported in the Journal of General Internal Medicine.

Health officials are nearly unanimous in stating that the burnout crisis will make it more difficult for patients to get needed care, cause an increase in health care costs, and exacerbate existing healthcare disparities. As a result, the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health has launched an initiative that “puts the onus on management, not workers.”

“All too often, steps to ease the burnout health care workers seem to start and end with variations of the advice to ‘take care of yourself,’” the CDC said. “Instead, a new anti-burnout campaign from the CDC and the National Institute for Occupational Safety and Health turns to leaders of the workplace, not the workers, for solutions.”

 The program, which is called “Impact Wellbeing,” aims to give hospital officials evidence-based resources to provide strategies to “reduce burnout, normalize help-seeking, and strengthen professional wellbeing.” Among the tools employed by the CDC are a questionnaire for workers to express their misgivings, workshops on topics like work-life balance, and “a guide encouraging leaders to share their own struggles with mental health to help encourage staff to do the same.”

Writing in the New England Journal of Medicine, U.S. Surgeon General Vivek H. Murthy said the root cause of burnout can be traced to systems. “Causes include inadequate support, escalating workloads and administrative burdens, chronic under-investment in public health infrastructure, and moral injury from being unable to provide the care patients need. Burnout is not only about long hours. It’s about the fundamental disconnect between health workers and the mission to serve that motivates them.”

Forbes magazine reported last year that many troubled healthcare workers do not feel valued. “The fact that nearly 7 in 10 clinicians do not feel valued from the work they provide is nothing short of disturbing, and healthcare systems should work tirelessly to be strong advocates of their own employees,” the magazine said.

The Harvard study noted that burnout disproportionately impacts women and minority groups “due to pre-existing inequities around social determinants of health, exacerbated by the pandemic.”

Surgeon General Murthy outlined a five-step process of actions to deal with the problem

“Addressing health worker well-being requires first valuing and protecting health workers. That means ensuring that they receive a living wage, access to health insurance, and adequate sick leave. It also means health workers should never again go without adequate personal protective equipment (PPE) as they have during the pandemic. Furthermore, we need strict workplace policies to protect staff from violence: according to National Nurses United, 8 in 10 health workers report having been subjected to physical or verbal abuse during the pandemic.”

”We must reduce administrative burdens that stand between health workers and their patients and communities. One study found that in addition to spending 1 to 2 hours each night doing administrative work, outpatient physicians spend nearly 2 hours on the electronic health record and desk work during the day for every 1 hour spent with patients — a trend widely lamented by clinicians and patients alike.”

“We need to increase access to mental health care for health workers. Whether because of a lack of health insurance coverage, insurance networks with too few mental health care providers, or a lack of schedule flexibility for visits, health workers are having a hard time getting mental health care. Expanding the mental health workforce, strengthening the mental health parity laws directed at insurers, and utilizing virtual technology to bring mental health care to workers where they are and on their schedule are essential steps.”

“We can strengthen public investments in the workforce and public health. Expanding public funding to train more clinicians and public health workers is critical. Increased funding to strengthen the health infrastructure of communities–from sustained support for local public health departments to greater focus on addressing social determinants of health such as housing and food insecurity–advances health equity and reduces the demands on our health care system.”

 A feeling that millions of health workers, including me, have had during our careers. Culture change must start in our training institutions, where the seeds of well-being can be planted early. It also requires leadership by example in health systems and departments of public health. Licensing bodies must adopt an approach to burnout that doesn’t punish health workers for reporting mental health concerns or seeking help and that protects their privacy. Finally, many health workers still face undue bias and discrimination based on their race, gender, or disability. Building a culture of inclusion, equity, and respect is critical for workforce morale.”

 “Today, we all have a role to play in preventing health worker burnout,” the CDC said. “Together, we have the capacity—and the responsibility—to provide our health workforce with all that they need to heal and to thrive.”