Tom Daschle is the latest "mover and shaker" to climb on the primary care bandwagon. In an opening statement to a Senate Health, Education and Labor and Pensions Committee confirmation hearing on his nomination as HHS Secretary, Daschle had this to say:
"Even Americans who do have health insurance don't always get the care they need, especially high-value preventative care. In some cases, this is due to a shortage of providers - especially primary care providers in rural areas ... CMS must focus on prevention and primary care, steering its resources toward wellness rather than sickness."
Still, it will be a tough slog, as Donald Rumsfeld so famously said about the Iraq war, before we'll be able to say that primary care's poor fortunes have been reversed.
Right now, primary care enjoys the support of leading organizations representing physicians, consumers, employers, and nurses. Yet this coalition could weaken if the following occurs:
1. Primary care could split into an uncivil war between doctors and nurses. Workforce studies project that the demand for primary care is so great that the U.S. will need more doctors and nurses. Yet primary care physicians and nurses could end up battling each other for a share of the pie.
2. Opposition by specialists could cause division in organizations that represent generalists and subspecialists - including ACP. An email from a rheumatologist-member of ACP has this to say about ACP's advocacy for a 10% pay increase for primary care:
"I did not see any mention of Internal Medicine subspecialties in your letter. We probably reflect about one half of the 126,000 members that are claimed. However, it seems to me that you do not represent me (as well as the other sub specialists) any more."
It is not pre-ordained that these conflicts have to happen. If we put patients' needs first, internists (both generalists and subspecialists) and nurses should be able to come together and agree on the need for more primary care clinicians, doctors as well as nurses. But it will require constant care and attention to make sure that primary care's coalition of the willing does not fall apart because of divisions within its own ranks.
Today's question: Do you believe that internists, generalists and subspecialists alike, and nurses will be able to stay together on the need for more primary care clinicians?