RWL #149 - PC, IQ, and HR
Greetings from the University of New Hampshire! And happy Saturday! It’s 25 degrees outside, there is frost on the ground, and all but a few of the last recalcitrant oak leaves have fallen. It’s days like these that really make me appreciate the privilege of having a snug house and a hot cup of coffee. I have a pile of papers to read, but right now I am enjoying the bright fall sun and having a quiet house. I hope you have a chance to relax and reflect this weekend, too.
On to the links!
Read
What: JAMA Catalyst, Pay for Relationship: A Novel Solution to the Primary Care Crisis
https://catalyst.nejm.org/a-novel-solution-to-the-primary-care-crisis/
Why: I’m not sure what I did on Monday to injure my shoulder, but by Monday night when I went to bed, I was in a lot of pain. I couldn’t raise my right hand above my shoulder, or lift my right arm out to my side. I don’t go to my PCM every time I have some sort of musculoskeletal injury. After a career in the Army, I learned the routine well enough - rest and “Vitamin M” (800mg Motrin). I figured a couple of days of taking it easy and anti-inflammatories would do the trick. The pain actually got worse, and my range of motion less, over the next couple of days. My officemate, a trained nurse and former hospital CEO, harassed me about getting seen as she watched me struggle to take off my coat in the morning. On Thursday morning I finally relented when I realized I could not reach forward with my right hand to turn the ignition on in my van (I had to reach across with my left hand, which is kind of awkward). Of course the first appointment I could get with my PCM (or another PCM on her “team”) was the following Tuesday. So I booked an appointment for later in the afternoon at an urgent care clinic not far from my house. It was easy to book, lots of choices, and convenient. I was treated very well by the clerk, the nurse, the PA, and the rad tech. The answer was, “sucks to get old”, get some rest, and “Vitamin A” (Alleve - I got generic naproxen - instead of Motrin). I felt like I was back in the Army. But I also felt like I was well cared for. By the time I left, I felt like I had established a relationship with my new providers.
In the two years I have had this PCM, I have seen her twice - both times to get referrals. I don’t really have a relationship with my PCM. She seems very nice. She gave me the referrals I asked for. We don’t really have a relationship, in part because of access (and the surrounding hassle of getting access). If I were to develop a serious illness or chronic condition, I would have to evaluate that relationship. For now, I’m a pretty healthy middle-aged guy who occasionally gets hurt in mysterious ways, so the status quo works. I’m not willing to pay more for a deeper relationship with my PCM. And that finally brings me to the article. Primary care in the US health system is broken and has been for decades. The interplay between reimbursement and provision of care has resulted in frustration by patients, miserable working conditions for primary care physicians, and excess use of specialty care. Make believe technocratic solutions like PCMH haven’t resulted in any real improvements. I concur with the overall premise of this article - that patients have to start paying for a relationship with their PCM. I’m skeptical of the rest - it sounds to me like more technocratic solutions that won’t actually work. I am convinced more and more that direct primary care (concierge medicine) where the patient pays a fixed access fee to their PCM for unlimited care from the PCM is the right way to go. The subscription model allows the PCM to stabilize earnings, eliminate billing and coding overhead, and most importantly reduce panel size. The reduced panel size allows for a real relationship and for the provider to get off the hamster wheel of 15 minute appointments.
I think the article is worth reading for the critique, and the solutions are worth thinking about as some sort of transition. But the real solution is to convert primary care to a subscription model with a small enough panel that access is guaranteed.
(BTW - my shoulder is 80% better thanks to Vitamin A and six days of rest. I probably didn’t need a visit after all.)
Watch
What: James Flynn TED Talk, Why our IQ levels are higher are higher than our grandparents’
https://www.ted.com/talks/james_flynn_why_our_iq_levels_are_higher_than_our_grandparents
Why: The “Flynn Effect” is an observation that IQ scores have been rising over time. The Flynn Effect is named after James Flynn, the speaker in this TED Talk. In this Talk, Flynn talks about why this effect is happening. The answer, in summary, is IQ is based on an ability to work with abstractions. Our economies demand progressively more abstract thinking. Simply, we’re getting better at it because we need to. It’s not that we’re smarter than our forebears. Very interesting talk.
Listen
What: Health Leader Forge, Aimee Giglio, CHRO, Dartmouth-Hitchcock Health
https://healthleaderforge.blogspot.com/2019/11/aimee-giglio-chro-dartmouth-hitchcock.html
Why: I’m pleased to share this month’s Health Leader Forge podcast, my interview with Aimee Giglio, the Chief Human Resource Officer for Dartmouth-Hitchcock Health System. The Dartmouth-Hitchcock Health System is a large health system based in New Hampshire with more than 14,000 employees.
Like many executives I talk to, Aimee didn’t start out in the human resources field. Her undergraduate work and early career was in the field of social work. Her journey to being the chief human resource officer for the largest employer in the state of New Hampshire after the state government is interesting, and the topic of the first part of the interview. We then discuss managing the human resources function for a major medical center and coordinating human resources strategy across a large system. We conclude with a conversation about leadership.
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
Have a great weekend and do amazing things!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
"I know of no more encouraging fact than the unquestionable ability of man to elevate his life by a conscious endeavor." - Henry David Thoreau