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Hope for Primary Care

A letter from Kim Leatham, MD
Virginia Mason Winslow Clinic - Bainbridge Island, Washington

Why We're Optimistic in the Face of all the Odds

Yes, there is already a shortage of primary care physicians in this country, and yes, it's going to get worse. The issues are well known: long hours of indirect patient care for which there is no reimbursement; low salaries for primary care physicians; payment based only on a physician visit and not on the care and relationship provided; medical students aren't choosing primary care for these reasons.

We feel that being part of the solution is the only way to continue to enjoy the practice of medicine.  There is an emerging boom of people entering middle and old age that will have chronic diseases and a longer life expectancy.  We are morally committed to taking care of the aging population and participating in Medicare.  With a shortage of primary care providers, we know that we cannot simply cut back on our panel size.  We are very committed to evidence based medicine and to helping our patients reach the goals and targets that are shown to improve the quality of their life and healthcare outcomes.

We are fortunate to be part of an organization (Virginia Mason Medical Center) that is using scientific methods learned from Toyota to eliminate the waste from medical care to make it more affordable.  We have also been fortunate to be part of TransforMed which has given us tools, advice and colleagues across the country to work with to change the model of primary care and keep our eye on the big picture and prize:  better healthcare for our patients, better job satisfaction for our staff and providers, better relationships and quality of life for patients, and lower health care costs across the system by providing care at a medical home.  We also attend IHI conferences for even more ideas and inspiration.

Looking back at our practice 7 years ago before beginning all this work, we all agree we are so much better off than the "old ways".  Newer technology, team based care, registries, e-mail with patients, focus on health maintenance at every visit, and evidence based medicine is so embedded in our practice now that it's hard to know why some long for the "good old days" (what was so good about it really?)

We are following with great interest and hope the tremendous shift in attitudes of big employers (both locally in our area and nationally), big insurers, health care agencies, researches, policy makers.  Now with the new administration which not only recognizes the need for reform of the healthcare system, but also has it as a top priority, we continue to work daily on improving our practice model and this keeps us optimistic.

The alternative is to despair, become negative and fall away from the future of family medicine.  We are energized by being part of the future and in shaping it.  We eagerly seek out residents in family medicine and internal medicine to do a rotation with us to show them the future and let them share in the vision.  We've come this far, there's no going back!

Kim Leatham, MD
Virginia Mason Winslow Clinic
Bainbridge Island, Washington

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