February 15, 2012 
“It has become increasingly apparent that doctors have to work with other people and share the care of patients with other professions, whether they are nutritionists, pharmacists, or nurse practitioners. You’ve got to be more collaborative, work as a team. There’s a different mind-set.” (Michael Dacey, SVP for Medical Affairs and CHMO, Kent Hospital)
I think this quote a recent article in Health Leaders (In Search of the Team Player, Feb 2012) makes a great point. Healthcare is changing. While I think we are seeing the pendulum swing back towards being more physician centric, the new model will be very different with quality measures and new technologies and the empowered patient.
The article shares some survey data that I found interesting. For example, while only 10% of physicians blame themselves for the “healthcare industry mess”, 30% of them believe they are the ones that will save healthcare. Certainly, physicians by themselves can’t change the model. We need payment reform and many other constituents with different agendas involved.
The article also shared a data point that 58% of physicians had ordered a test or procedure in the past year for purely defensive medicine reasons which is a sad reality. At the same time, I know that many of us when faced with those tough decisions for ourselves want to jump through hoops to do everything possible even if it doesn’t offer a good ROI.
The issue of the impending physician shortage (see Washington Post blog) can be mitigated by engaging these other professions in a care team strategy, but will physician’s embrace this. 26% of physicians surveyed thought that increasing the scope of care for nurses would worsen the quality of care and 13% say that abuse or disrespect of nurses is common. Fortunately, everyone wants the same thing which is cost-effective care that improves outcomes and the quality of life. The challenge is finding a solution to do that.
Enabling Healthy Decisions 
Primary Care Is At Risk of Collapse and Needs the Addition of the 200,000 plus readily available Pharmacists as Physician Extenders
The Primary Care Physician component of the portfolio of healthcare providers is not doing well. Fewer graduating medical students are seeking careers in primary care. In 2005, only 4 out of 100 University of Tennessee medical school graduates choose primary care careers according to Family Medicine Department Chair, J. Mack Worthington, M.D. Further, of the 4 physicians entering the primary care arena, only 2 will remain after 10 years of practice. The New England Journal of Medicine reported, “The American College of Physicians recently warned that “primary care, the backbone of the nation’s health care system, is at grave risk of collapse.”
Yes, the great majority of patients prefer to seek initial care from a primary care
Physician rather than a specialist, but their unhappiness with their primary care
Experience is growing according to Wennberg. Patients are increasingly dissatisfied with their care and with the difficulty of gaining timely access to primary care.