More Fuel For the Primary Care Physician Fire

For those of you following, I have had multiple posts here, here, and here regarding an initiative that I think we need to get aggressive on-branding with primary care physicians for musculoskeletal exam and treatment.  This is due in large part to the shortage of primary care docs that will be around for awhile as well as the transition of our own profession to direct access and autonomous providers.  Others, namely nurses are aggressively pushing this extender position and we need to put ourselves in a similar position.

This blog post appropriately titled, The End of the Primary Care Physician further adds fuel to this fire.  It references and links several op-ed pieces including 2 WSJ  pieces including one on Dr. Nurses) and a JAMA commentary.

We need mass promotion of our transition to doctorate and our expertise in musculoskeletal medicine.

We need to be leaders in helping Primary Care Medicine new definition.  This fits well into the medical home model as well.

thoughts?

Larry@physicaltherapist.com

 

Comments

[Selena Horner]

Bottom line is that primary care is no longer lucrative. Physicians are instead choosing careers in dermatology which is definitely lucrative.

We can step up and be considered as an option, but bottom line is we are going to want to be paid adequately. If there is a business model out there that would allow us to fill that role AND be profitable, that would serve the needs of both society and us as professionals.

[cjk]

I cannot agree with you more, Larry. We have no teeth, even as DPTs, and the opportunity is NOW to establish ourselves as major players in healthcare!
Is the APTA responsible for representing us in this process???? I continue to think there is either too much apathy or contentness at mid & high levels of the organization; they are greatly out of touch, slow, and reactive when we should be doing what nursing is in actively *planning* their future. As a 7-year active member of the APTA, I have no idea what we are actively pursuing beyond Vision 2020. Instead, we seem to spend most of our resources playing defense. How are we adapting to be a part of the future?

[Jeff Hathaway]

This is our opportunity to fundamentally change private practice. I believe we can flip from an ortho dependant profession to a front line provider. What about a model that puts us as the MSK evaluator (don't like the word extender but...) in a PCP's office then we see pts from that service back in our clinics? Given the PCP shortage we have in essence increased their practice volume by 25% (avg % of MSK in a PCP office) and we get the referrals more in line with the evidence and before the ortho. The big question is how would we structure this to pass the ethical and Stark/Kickback issues??

[Christie Downing]

Consider the fact that 82% of medical school graduates fail to demonstrate a compentent musculoskeletal exam....now is our time more than ever.

Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. American Journal of Bone and Joint Surgery 80:1421-1427, 1998.

[John Ware]

Jeff's onto something. The value of accurate and timely diagnosis is grossly under-reimbursed in the current system. This is why people flock to places like Mayo Clinic and Cleveland Clinic for something as simple as a chronic headache, but unfortunately once they get there, the condition has become so chronic and complex, it's become much more difficult to manage.

Timely and accurate MSK diagnosis could be performed by qualified PTs as primary care providers and have a tremendously positive impact on our heatlth care system in terms of both quality of life and cost savings.

Figuring out how to convince insurance companies to make it worthwhile for PTs to be paid as diagnosticians is the hard part.