A View From The Trenches of Primary Care

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I recently retired from clinical practice at Family Medicine Associates, LLC in Manchester, MA after four decades on the front line in primary care medical practice. I truly enjoyed caring for my patients and the close bonds we formed over all the years. But during all those years in the trenches I have seen American healthcare change drastically, often not for the better, due to advances in technology and economic pressures. After spending the last 40 years working hard to learn and adapt, now I want to focus on contributing to the critically important effort to solve that crisis.  

I started as a new solo practitioner in a rented apartment in our small town (oblivious to even the zoning rules). As I learned my way in the system and the patient volume grew, I added nurse practitioners to work alongside me and quickly grew to appreciate the tremendous value that they add to primary care delivery and the health system as a whole. With the advent of managed care, I joined with 2 other solo family doctors to form a group that quickly grew to 10 family doctors and 17 nurse practitioners in 3 locations. As our healthcare system changed, I designed efficient office processes that emphasized a team approach and required staff to take initiative and work at the top of their training, abilities, and licenses. We focused on high quality care and eventually became a level 3 certified “Patient-Centered Medical Home”. I strived to coordinate mental health care with general medical care, to improve preventive health care, and to integrate high quality alternative healthcare options with traditional health care. I always optimized our outreach to patients and my practice consistently achieved top care quality scores.

I was also very involved in hospital medical staff affairs and eventually became the medical staff President with primary responsibility for assuring top quality care within the entire hospital system. During that time, I gained deep knowledge of the inner workings of our local and regional hospital systems. And we also formed physician and physician-hospital organizations to contract with insurers to guarantee the high-quality care required by those contracts and create programs to help us manage the shared economic risk associated with those contracts.

Throughout my career, I have always focused on championing the value of primary care.  I worked tirelessly to bring Family Medicine to our local hospital and the Boston area. I established a department of Family Medicine at our local hospital that has since grown to 42 board-certified family doctors and eventually included a highly regarded residency program in Family Medicine. With the support of the Massachusetts and American Academies of Family Physicians, I pushed the four Massachusetts medical schools to advance their programs in Family Medicine. These efforts led to the creation of a statewide community physician mentorship program in Family Medicine and the establishment of full departments of Family Medicine and residency programs at BU and Tufts, the strengthening of the UMass program, and a significant increase in training opportunities in family medicine at Harvard.

I believe strongly that we need thoughtful transformation in healthcare delivery and that meaningful change requires a systematic rather than an individual approach. Our medical training programs also need to change to produce providers who are well prepared to work effectively within the new healthcare paradigm. I have spent years independently attending conferences and reviewing the newest literature on the most recent and effective population health delivery ideas and systems (especially IBM Watson) and have long participated in the NEJM Catalyst programs. I have continued these pursuits even since my retirement from active clinical practice.

My experience on the front lines of medicine leaves me uniquely positioned to advise clients on how to adapt to the new, emerging healthcare environment, whether by advising practices and healthcare delivery systems on how to bring meaningful, innovative change to healthcare delivery or by helping biomedical device, technology, diagnostic, and pharmaceutical product developers to make practical and effective products for the real-world marketplace.

By forming Primary Healthcare Solutions for healthcare consultations and through my blogs, I hope to share my ground-level perspectives and suggest pathways to meaningful solutions to the current healthcare crisis. I welcome your thoughts and inquiries since I also firmly believe in the power of teamwork and “brainstorming” from different perspectives to arrive at the best solutions.