DFM Faculty Play Leadership Role in UW Health Primary Care Redesign Initiative

Two Department of Family Medicine (DFM) faculty are operational leaders in an important initiative that aims to redesign primary care delivery at UW Health.

The initiative, launched in October 2008, is a response to the urgent primary care crisis in Wisconsin. And although the project is still in its formative stages, Sandra Kamnetz, MD, and Valerie Gilchrist, MD, the DFM faculty who serve on its steering committee, are optimistic about how it can benefit physicians, clinical staff, and patients.

Roots of the Primary Care Crisis

Wisconsin, like much of the nation, is struggling with a shortage of primary care physicians. This shortage, the result of a decade-long national thinning of the ranks, is due to relatively poor compensation, lack of resources, and increasingly burdensome restrictions on care delivery-all of which have resulted in physician burnout and rejection of the field by medical students.

In the introduction to a primary care redesign roundtable recently published in the New England Journal of Medicine, the primary care physician's challenges were characterized as follows: "...too many patients, too many demands, too much information flowing through, too little time to do a good job. These problems are exacerbated today by a compensation system in which there are many other options that pay considerably better. And the compensation system does not necessarily reward you for doing what matters most."

In Dane County alone last year, according to Dr. Kamnetz, three UW Health internal medicine physicians left outpatient clinic practice to become hospitalists, four other internists left to practice in other cities or organizations, and five family medicine physicians moved to other cities or to immediate care. As a result, the number of patients seeking care at family medicine clinics has increased, inundating the already strained system and staff.

Unfortunately, the physician shortage, combined with systemic fragmentation, takes its toll on patients. Nationwide and in Wisconsin, primary care patients express frustration over access to doctors, coordination of care, and perceived poor quality of care.

According to Dr. Kamnetz, recognition of the crisis' severity by UW Health's leadership was the impetus for the redesign project, says Dr. Kamnetz. "This effort says, 'We can't continue with the one-patient, one-doctor-at-a-time model of care'," she said.

Envisioning the Future of Primary Care

The redesign project formally began on October 1, 2008, at a retreat sponsored by leaders from all three units of the UW Health enterprise: the UW Medical Foundation, UW Hospital and Clinics, and the UW School of Medicine and Public Health.

During that retreat, representatives with diverse roles in primary care began drafting a shared vision of what primary care at UW Health should look like in 2012. Contributors included receptionists, physician assistants, nurse practitioners, physicians, and organizational leaders.

Participants then shared the documents generated during the retreat with other faculty, staff, and patients at UW Health clinics. "We talked to people at the front lines-receptionists, technicians, nurses-and asked them to tell us what they need," said Dr. Kamnetz. "We're really trying to engage everybody and have them give feedback."

With all feedback collected, the steering committee is now polishing the vision statement and identifying short-term goals-relatively simple, quickly implemented changes to help people do their jobs more effectively.

By mid-2009, the committee hopes to have completed those short-term initiatives and completed a plan for long-term change.

Recurring Themes and Goals

Although the project's vision is still in its early stages, numerous themes permeate the discussions and plans. These include:

• Promoting a culture of respect and trust;
• Empowering patients and clinicians;
• Valuing all members of the healthcare team;
• Optimizing existing and new technologies;
• Providing easy, convenient access for patients;
• Building a culturally sensitive environment ;
• Instilling changes that are achievable, flexible and affordable.

Primary care in the future will emphasize flexibility, integration, technology, and community. Achieving that will require not only organizational changes, but working with patients and seeking their input.

"We want to accomplish specific goals: alleviating the physician shortage and improving the quality of care for our patients," said Dr. Kamnetz.

And according to Dr. Gilchrist, that's great news for the DFM. "We have an opportunity to explore different ways of delivering primary care that will increase quality, patient satisfaction, and clinician satisfaction, and can also inform primary care elsewhere in the country."

She added, "We can look after our patients effectively and efficiently, providing care for most patients' problems most of the time. Working as a team will allow us to return physicians to where they really want to be-with their patients."