The looming physician shortage facing the nation has been troubling many hospitals and health systems across the country. Many organizations are improving their physician recruitment tactics in order to attract more physicians in a competitive market, and others are increasing residency slots in order to produce more future physicians.
Saint Francis Hospital in Hartford, Conn., decided to take a different approach. Saint Francis teamed up with the University of Connecticut School of Medicine to create the Connecticut Institute for Primary Care Innovation, which aims to improve primary care education and increase the retention of primary care providers, among other goals. New dedicated space for the CIPCI opened in November.
"The physician shortage has multiple drivers," says Crystal Clark, MD, the director of the CIPCI. A lot of the changes happening due to healthcare reform, such as coordinating care and leading care teams, fall on the backs of primary care providers. These are tasks that many primary care physicians have not been responsible for in the past. The addition of these tasks, on top of their current workload and the fact that primary care physicians traditionally make less than specialists, has made primary care unattractive to many physicians.
There also seems to be a stigma surrounding medical students who choose primary care over a specialty. "Sometimes really good medical students want to go into primary care but hear things like, 'you're too smart and talented for that.' And that's the wrong message," says Gregory Makoul, PhD, senior vice president for innovation and chief academic officer of Saint Francis and professor of medicine at the UConn School of Medicine.
"All of these things have led to challenges of getting people into primary care and staying in," says Dr. Clark. "We believe the institute can attack a lot of those drivers on multiple fronts."
The institute leads research on how to improve primary care training and helps practicing primary care physicians keep pace with healthcare changes.
Simulating care to improve efficiency
Utilizing a new simulation studio is one way the CIPCI hopes to make primary care more efficient. "It's a giant open space that can be turned from one thing to another very easily," explains Dr. Makoul.
The space can be set up to look like any specific primary care office suite so physicians from the area can examine their office's work flow and efficiency.
"We can put computers in different places and see how that affects work flow," says Dr. Makoul. Primary care physicians can also experiment with where medical assistants sit or what happens at the front desk. "Simulation doesn't interfere with the actual practice environment, so it is safer — and cheaper — to experiment here."
The CIPCI simulation studio is also equipped with state-of-the-art video equipment. "Physicians and teams learn so much from seeing what's going on on the tape," says Dr. Makoul. "That's the key to learning and changing behavior and flow." Watching work flow back on tape is beneficial for physicians much like it is beneficial for athletes who study their game tape.
Improving the efficiency of primary care offices will help with the physician shortage by allowing existing physicians to use their time in the best way possible.
Future impact
If all goes according to plan, the CIPCI will help all primary care physicians, not just physicians in Connecticut, become more efficient. "We are serious about learning and sharing our learning," says Dr. Makoul. "The CIPCI can be a national and international model."
The CIPCI is overseen by a governing board and has built both a local advisory board and a national primary care policy council, which will help guide the institute through future changes in healthcare. "The policy council will help us stay ahead of the curve in terms of where primary care is headed," says Dr. Makoul.
"Our advisory board and council can help us be truly innovative and focus on all of the disciplines," adds Dr. Clark. "We have a body of people that help us keep the direction in front of us and coordinated."
In the future, Dr. Clark hopes that the institute will increase enjoyment for primary care physicians and that it will improve primary care for all people involved in it, even the patients. "That is my hope, and I think centers like this can actually accelerate that to happen. That's a ground game and we have to be…the place to try these things…we have to reignite the spirit of primary care."
Making primary care more enjoyable for physicians will increase primary care retention down the road and make it a more attractive choice for medical students choosing what type of medicine to practice. All of these things will help with the future of the primary care physician shortage.
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