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3 Primary Care in the United States: A Brief History and Current Trends
Pages 71-92

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From page 71...
... The first neighborhood health centers focused on primary care, which became today's health centers,1 were also established in the mid-1960s as part of President Lyndon Johnson's War on Poverty (CHroniCles, 2020) , and the nurse practitioner (NP)
From page 72...
... . Increasingly, though, they also work with an interprofessional team that may include community health workers (CHWs)
From page 73...
... . It is surprisingly difficult, however, to describe the broader primary care workforce in detail, because national data neglect many professions, such as behavioral health specialists, pharmacists, health coaches, and others who make up interprofessional primary care teams (see Chapter 6 for more on the workforce)
From page 74...
... As cited earlier in this chapter, the National Sample Survey of Registered Nurses offers estimates of those practicing in primary care (HHS et al., 2020) but does not provide a broader workforce enumeration and monitoring function the way that the American Medical Association Physician Masterfile4 or the Health Resources and Services Administration 4  See https://www.ama-assn.org/practice-management/masterfile/ama-physician-masterfile (accessed February 14, 2021)
From page 75...
... Primary Care Specialties Another notable change from earlier generations of primary care is the growth of primary care specialties, including family medicine, general internal medicine, general pediatrics, adolescent medicine, and geriatric medicine, each with its own professional organizations and advocacy groups (Dalen et al., 2017)
From page 76...
... Recapturing this generalist function was the main call of the 1966 American Medical Association Graduate Medical Education report (commonly known as the "Millis Commission" report) that helped birth family medicine (Citizens Commission on Graduate Medical Education, 1966)
From page 77...
... CURRENT PRIMARY CARE PRACTICE TYPES As of 2014, some 56 percent of primary care physicians worked in practices in which they were full or partial owners, while 41 percent were employees, of either a physician-owned or non-physician-owned practice (see Figure 3-2)
From page 78...
... FIGURE 3-3  Distribution of primary care physicians in non-physician-owned practices, 2014. NOTE: HMO = health maintenance organization.
From page 79...
... A 2017 study found that between 2010 and 2016, the percentage of primary care physicians working in a practice owned by a hospital or health system increased from 28 to 44, and the percentage of those working in an independently owned practice decreased by a similar amount (Fulton, 2017) (see Figure 3-4)
From page 80...
... . In addition, policy makers are concerned that increased use of retail clinics will create missed opportunities for preventive care, make coordination and continuity of care more challenging, and pose a threat to the financial viability of primary care practices by treating the latter's most profitable cases (Weinick et al., 2011)
From page 81...
... . The increase in health systems starting urgent care clinics is a mechanism to link the person who visits an urgent care clinic when their primary care service is closed back to the larger primary care network.
From page 82...
... .6 These designations are often used by the HRSA to prioritize funding for health centers and by the Centers for Medicare & Medicaid Services (CMS) for reimbursement and payment incentives for primary care clinicians (CMS, 2019)
From page 83...
... Advanced, interprofessional primary care models do not presume that these clinicians have identical roles but rather that they offer a combined, broader scope of services that their unique training and experience support. Factors other than clinician supply limit access to primary care, including lack of health insurance (Ayanian et al., 2000; Freeman et al., 2008; Hadley, 2003; Tolbert and Oregera, 2020)
From page 84...
... . The changes in visit type may also be a reflection of people choosing convenient visits to urgent care and retail clinics for problem-based care, while maintaining yearly scheduled wellness or preventive care with primary care clinicians.
From page 85...
... The insufficient supply of primary care clinicians and their uneven geographic dispersal leads to an inadequate supply of appointments, particularly for the often last-minute needs of problem-based visits (Ganguli et al., 2019)
From page 86...
... 2019. Occupational employment and wages, May 2019: 21-1094 community health workers.
From page 87...
... 2019. Primary care office visits for acute care dropped sharply in 2002–15, while ED visits increased modestly.
From page 88...
... U.S. Retail clinics market size, share & trends analysis report by ownership type (retail-owned, hospital-owned)
From page 89...
... 2015. Practice and power: Community health workers and the promise of moving health care upstream.
From page 90...
... 2018. Community health centers con tinued to expand patient and service capacity in 2017.
From page 91...
... 2019. Primary care nurse practitioners and physicians in low-income and rural areas, 2010–2016.


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