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Doctor’sprimary concern

(Essdras M Suarez/Globe Staff)
April 16, 2012
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WHO

Dr. Russell S. Phillips

WHAT

Phillips, a doctor at Beth Israel Deaconess Medical Center, was recently named the inaugural director of the Harvard Medical School Center for Primary Care, which develops solutions to the problems of primary care.

Q. What is wrong with primary care today?

A. Primary care in this country is in crisis. We know that countries with strong systems of primary care provide higher quality of care at lower cost. We need to think about the way that primary care is practiced, so as to make it more attractive to our [medical] students, provide more resources for the work that primary care doctors do, and advocate for payment reform.

Q. Part of the problem is that being a primary care doctor these days isn't a particularly appealing job?

A. Only 2 percent of medical students are interested in going into primary care and we need to fix this. We need to make the profession attractive enough so that more people will want to do it. Oftentimes, because we don't have functional teams, doctors are being asked to do things that do not require a physician's level of training. If the work we do is not manageable and rewarding, then [the aging workforce of primary care] doctors will retire rather than do the important work.

Q. What's daily life like as a primary care physician?

A. If you did everything that was recommended in terms of prevention and counseling, the average workday would be 18 hours. Most doctors in this area are seeing patients 28 hours a week, and spending much of the rest of their time handling correspondence, follow up, seeing patients in the hospital, managed care referrals and the like.

Q. Despite the challenges, you plan to continue to see patients one day a week while you run the center?

A. It's one of the most rewarding things that I do. I have patients I've cared for for over 30 years and I can't see giving up those relationships.

Q. Specifically, what do you think doctors need today that they don't have?

A. If I have a patient who's very sick and I'm worried they're at risk of being admitted to the hospital, it would be great to have a nurse practitioner visit them at home. But I don't have capability to provide that service to my patient.

Q. What do you plan to address first as the new head of the primary care center?

A. The four major areas in which we're looking to create redesign is around: enhancing team-based care, population management for patients with chronic disease, management of patients at high risk, and to improve patient engagement and empowerment.

Q. What role do patients themselves have to play?

A. Patients who are more involved in their care also have better outcomes. Part of what we're trying to do is use information technology, counseling, health educators, other resources, to try to get patients as informed and engaged as they might be in their [own] care. Some of it is doctor time, some of it is spending time with other members of the care team, some of it is improving Web-based interfaces.

Q. Obviously, none of this will be easy.

A. It's a huge challenge, but it's a challenge we can't afford to fail. It's clear that our economy cannot continue to absorb increases in the costs of care, so we need to do things to bring costs under control. Improving the system of primary care is critical to that effort. We also need to improve the quality of that care. We need to take this on and we need to be successful. Karen Weintraub

This interview has been edited and condensed. Karen Weintraub can be reached at Karen@KarenWeintraub.com

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