Spokane physician proposes changes

It’s not uncommon for a medical school student to be told he or she is “too smart” to be a family physician, said Glen R. Stream, a family doctor from Spokane. He wants Congress to help change that.

Along with doctors from Kentucky, Louisiana, Michigan and New Mexico, Stream discussed ways to cut health care spending at a meeting of the Senate Finance Committee this week. The president of the American Academy of Family Physicians, Stream also expressed his specialty’s views on the way Medicare pays doctors.

With more evidence showing family doctors play a foundational role in the health care system, Stream said the bias against family medicine is changing. But the salary is still relatively low.

“There’s a huge gap between what primary care is paid and subspecialty is paid,” Stream said. “That gap is a significant barrier to students choosing primary care.”

This has resulted in a huge dearth of family doctors: The academy predicts the country will be short 39,000 family physicians in 2020. “We have a lot of people at my age who are close to retiring, and we don’t have a pipeline of candidate positions prepared to take their place,” Stream said.

To help solve that problem, he suggested Congress authorize a 10 percent bonus to primary care doctors and nurses for some services they provide to Medicare patients. He also described a long-term program, which he called “a game changer,” to help build solid primary care, called Patient-Centered Medical Home.

It’s not a physical location but a model of care featuring teamwork and patient outreach, tracking and follow-up. The physician is no longer the single source of health care, but part of a team. Different members track patients’ electronic health records, coordinate the appointments on computers, and reach out to patients regularly. Such a system also expands hours to give patients access to care when needed.

“It’s taking responsibility for the patients not just when they choose to come in for a face-to-face appointment, even between appointments,” Stream said.

The program is being tested in 18 states; Regence Blue Shield and Group Health of Washington are trying it in Washington.

In a report to be published later this month, figures show patients in these programs have fewer visits to emergency rooms and fewer hospitalizations, cutting health care costs.

But when asked by Sen. Maria Cantwell, D-Wash., if there are enough doctors and other medical staff to implement the strategy, Stream said “absolutely not.” The model should be set as a goal, he said.

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