- Train more primary care physicians
- Broaden the use of family medicine
- Pay PCPs better
- Release the legal shackles on the activity of nurse practitioners and physician assistants
There's another possibility: making better use of the many current specialist physicians who act, in part or much of the time, as primary care providers. I am talking about cardiologists, psychiatrists, endocrinologists, gynecologists - anyone who has a long-term relationship with a patient.
But wait - these specialists have not been trained to provide primary care! True. But we know now, in the current system, that there are few physicians (or nurses) actually providing every kind of care a patient needs without recourse to specialists. That being the case, it should be possible to figure out which elements of comprehensive care various specialists can provide - thereby enlisting the help of all providers in a coordinated effort. This is not a new idea, as a cursory search shows; but perhaps its time has come.
It should be possible, for example, to determine that Ms. Gonzalez actually sees her cardiologist the most often of any of her doctors, and, using a coordinated electronic medical record, to have her undergo colon cancer screening at that cardiologist's office; or her medications refilled; or her immunizations.
There has been a long and storied history of cross-purposes, and even suspicion, between general practitioners and specialists. Why not turn that relationship on its head and try to share some of the increased responsibility of care coming our way?