Solving the Primary Care Crisis

A University of Missouri School of Medicine professor has examined a new approach to delivering primary care in an article published in the New England Journal of Medicine in January 2010. Titled “Patient-Centered Medical Homes in Ontario,” the article addresses how a Canadian province’s experiences could provide useful lessons for the U.S in improving health care access and quality for patients.

Co-author Jack Colwill, MD, professor emeritus of family and community medicine at MU and Institute of Medicine member, believes Ontario’s Family Health Team (FHT) model could apply to U.S. health care reform.

“What they are doing is exactly what I think needs to be done in this country,” Colwill said. “We face a tremendous shortage in primary care, which is only going to get worse. At the same time, we’re about to pass health care reform legislation that is going to increase demand for primary care. However, we don’t have much movement thus far to increase the number of physicians in primary care.”

Colwill served as a lead author in a 2008 Health Affairs study published by researchers from MU and the U.S. Department of Health and Human Services that predicted population growth and aging will increase family physicians and general internists’ workloads by 29 percent between 2005 and 2025. The number of graduates in family medicine and general internal medicine actually declined 21 percent between 1998 and 2005.

Colwill learned about the new model of primary care being implemented in Ontario from the NEJM article’s lead author, Walter Rosser, MD, professor emeritus in the Queens University Department of Family Medicine. Colwill approached Rosser in early 2009 to find out more about the model’s effectiveness.

According to the NEJM article, the FHT model is designed to expand the capacity of primary care through the development of multidisciplinary teams that focus on providing more comprehensive service and coordinating patients’ care throughout the system. The model provides a reimbursement system that creates incentives for physicians and nurse practitioners to enhance preventive care and provide more proactive management for patients with chronic illnesses. More than 1 million Ontarians have enrolled in FHTs since 2004.

Colwill is a former chair of MU’s family and community medicine department and has been a member of the Institute of Medicine of the National Academy of Sciences since 1989. MU’s family and community medicine department has been ranked as one of the top seven family medicine programs in the country for the past 15 years.