HomeWhat's NewPerspectivesHope for Primary CareLetter from Randall Rickard, MD

Hope for Primary Care

A letter from Randall Rickard, MD
Family Practice Partners - Murfreesboro, TN

I have read of the demise of primary care. Our healthcare system will be without enough of the doctors it needs most to fix its costly and disjointed efforts.  It does sound hopeless. These warm-hearted clinicians chose a job where they could care for people. They trained to evaluate and care for all the problems a person might have. They did not factor in the explosion of information they need to master, the third parties that stifle their payments, and the volume of work they need to do for their job for which there is no payment. To focus on quality work and improve safety expands their overburdened workload without changing their pay. To focus on their need for income, they simply must push people in and out of their doors. Volume work satisfies neither patient nor doctor.

I ought to know something about these problems. I have practiced the craft for 27 years. Yet I seem to have more hope that these problems will be solved. I have a vision that primary care can regain its sensible place as the foundation of a remade medical care system. Through attention to innovation and forward thinking going back almost a decade, our practice has sought to build a "better mousetrap". The transformation to our current hopeful state accelerated ten-fold three years ago with involvement in the AAFP TransforMED project aimed toward creating the "practice of the future". Since its conclusion a year ago, we have continued to mature in such a way that the vision seems more of a reality than an idea.

The process of change gained needed direction by clarifying our vision of what primary care needs to do to meet the needs of patients.  Important essentials included learning how to deal with change successfully and putting in place the tools to have success. Change then could accelerate upon learning how to use those tools to their best advantage.  As a result, we learned how the human endeavor of an office practice needed to be run to accomplish these goals to everyone's satisfaction.

Prior to our involvement with TransforMED we were well on our way to maximizing our use of technology to improve our access, quality, and safety. This process has continued to evolve within our office, and the available technology continues to evolve to aid our effort. It is gratifying to see improvements in computer programs and systems addressing the very tasks congealing as the vision of the ideal practice.

TransforMED refreshed and renewed our sense of what we wanted to do when we went into primary care in the first place. Centering on the patient is a simple concept that can be hard to grasp. Now that I am immersed in the idea, I report it feels better as a provider to have matured to this approach. I sense it feels better to the patients as well. My partners and I focus on their agenda and identifying their needs. It is more appealing to patients and more cost effective to the system as they do not necessarily want expensive tests and procedures.

Key among the lessons we have learned is the importance of seeing patients when they want to be seen so as to provide them care when they feel they need it. Patients' needs do not end when the office closes for the day, so our practice coordinates with others in the community to "always be there" in some fashion. After 27 years the power of a healing relationship is overtly evident and more gratifying when seen in the new light of patient- centered care. As registries mature in our computer software, I look forward to expanding our current effort to look to my patient's health even when they are not in my office asking for care.

TransforMED's largest boost to our practice was the development of the tools on the human side. The concept of "team" has hit home with their help, and its evolution into full function continues. This has made the world of difference in the satisfaction of both providers and patients. Understanding how to make this part of the practice work well completed a loop to allow integration of all parts.

Our team uses technology to address the clearly stated goals our practice has set to do our job well with great satisfaction. Together, we maximize our quality of care, engage in prevention at every possible turn, and think safety as we make our decisions. We reach out to improve the health of those in our care and accomplish more than any physician could do alone. We know this to be high quality, doable, and enjoyable primary care. From that realization springs our hope that people will see this and appreciate it. Perhaps medical students will see what we do and choose to emulate our efforts. Their services are badly needed and, if they can only see it as possible, their idealism and mastery of technology will make them naturals for the rebuilding of our healthcare system's foundation.

Another group that needs to appreciate what we do is the payer system. We have done what we have done on our own dime.  It is not cheap. Even in the current system, we are seeing our income rise a bit, but I dare not calculate a "return on investment" for fear of scaring off possible new primary care providers. Payment reform can help cement the weakest corner of the new model under construction. The fear that these efforts will never make it to its full promise is real as medical school graduates are too burdened with debt to ask them to finance this effort on their own with little compensation in the offing.

Even without payment reform, I like my practice more now than I ever have before. My staff is the happiest it has been in a decade. My patients smile more as they like what they experience in the way of care. I am going north when others are going south, and I want to show others my path. There is a vision to guide us, and there are tools to make it happen. When there is payment to match, we can motivate idealists entering medicine to build a cathedral of a medical care system to replace the strip mall we now have.  I have been lucky to be in a transformed practice with hope for the future of my specialty and the healthcare of our country. I would love to share this hope with all who will listen.

Surely society will recognize the good that primary care provides for people. There needs to be a way to compensate these doctors for necessary and desired but currently unpaid care. If the payment obstacle is solved, I stand with my transformed colleagues holding a beacon of hope to salvage the healthcare system for the next generation. Primary care can be done well with joy. It is needed desperately and surely others outside its practice will begin to recognize its value and compensate for its contribution to the health of our society.

Randall Rickard, MD
Family Practice Partners
Murfreesboro, TN

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