Sunday, April 21, 2013

When It Comes to Nurse Care Managers in Primary Care Settings, It's Not "Build or Buy," It's INVENT or Buy

Seen one of these lately?
The Passenger Pigeon. The Dodo bird.  The primary care clinic nurse.  All are extinct, driven out existence by a changing habitat, competition and over-hunting. Ask the average person when they've last seen these species and you're likely to get the same baffled look that the of DMCB spouse gives when she's asked about her compliant husband who does what he's told.

Yet, the Disease Management Care Blog wasn't aware of the primary care nurses' total absence until a recent conversation with a nurse-colleague who has been helping smaller physician-owned outpatient offices develop local care management programs.  "There are no 'nurses'" she said. "They've all been replaced by office assistants and the docs are trying to get them to do the patient education."

Which makes sense. While articles like this have been lauding health care "teams" made up of physicians and non-physician professionals for years, the fact is that poor reimbursement, the allure of other specialties and lifestyle has long-hollowed out these clinics, often leaving a skeleton crew of part-time medical assistants shuttling patients in and out of the patient rooms.  True, some of the larger health systems with a stake in primary care have kept nurses in the mix, the DMCB thinks that's merely part of a market-preserving loss-leader strategy.

The DMCB looked for medical literature on the topic.  It can't find any surveys or other descriptions on how nurses have largely disappeared from the primary care landscape.  If it's wrong, it wants to hear from its readers.

If true, what are the implications?

  • In large swaths of the primary care landscape, there is no "build or buy."  It's invent or buy.

  • What's more, younger PCP's are even less familiar with the notion of an office-based nurse, let alone partnering with one.  Physician knowledge may have gone extinct too.

  • No wonder the Patient Centered Medical Home hasn't caught on.

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