Bolstering the pipeline for primary care: a proposal from stakeholders in medical education

Primary Care Physician Supply and Population Health Outcomes in Florida, 2010-2019

Background

Primary care physicians play vital roles in the prevention and management of chronic disease. With increasing rates of chronic disease and a national primary care physician shortage, the role that primary care physician supply has on health outcomes in Florida is not well understood. The objective of this study was to investigate the relationship between primary care physician supply (PCPS) and population health outcomes of obesity, life expectancy, coronary artery disease hospitalization, and death rate as reported by county in the state of Florida for the years 2010, 2013, 2016, and 2019.

Methods

This was a retrospective, cross-sectional study. Secondary data was used from the Florida Department of Health. Numerous population health and social determinants of health variables related to PCPS in the literature were selected for analysis. Correlation and linear regression analyses were conducted using STATA14.

Results

The association between PCPS and obesity was the strongest association in this analysis and was significant for each year with an average of 9.25 primary care physicians per 100 000 people needed to decrease the obesity rate by 1%. PCPS was positively correlated with life expectancy for years 2013, 2016, and 2019 and negatively correlated with the death rate in 2010 and 2019. In the multiple regression, PCPS was negatively associated with areas having a high rate of uninsured persons, unemployment, decreased education, and age over 65.

Conclusion

Increased supply of primary care physicians in Florida is significantly associated with decreased rates of obesity and death and increased life expectancy. Our results also indicate that areas with higher levels of social vulnerability also have inequitable distributions of PCPS. Therefore, PCPS should be increased, particularly in areas with the highest need, as primary care physicians in the state of Florida play an important role in improving the overall health of the populations they serve.

Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce: An Official American Thoracic Society Workshop Report

Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.

Primary care physician leaders’ perspectives on opportunities and challenges in healthcare leadership: a qualitative study

Background

There is an increasing demand for physicians to assume leadership roles in hospitals, health systems, clinics and community settings, given the documented positive outcomes of physician leadership and the systemic shifts towards value-based care. The purpose of this study is to examine how primary care physicians (PCPs) perceive and experience leadership roles. Better understanding how PCPs perceive leadership affords the opportunity to influence changes in primary care training in order to more adequately prepare and support physicians for current and future leadership roles.

Methods

This study used qualitative interviews, conducted from January to May 2020. The participants included 27 PCPs, recruited via the Harvard Medical School Center for Primary Care newsletters and through snowball sampling techniques. Participants worked in 22 different organisations, including major urban health systems, corporate pharmacy, public health departments and academic medical centres.

Results

Using content analysis and qualitative comparative analysis methodologies, three major themes and seven subthemes emerged from the interviews. The primary themes included the advantage PCPs have in leadership positions, the lack of leadership training and development, and disincentives to leading.

Conclusions

While PCPs perceive primary care to hold a unique position that would incline them towards leadership, the lack of training and other noted disincentives are barriers to leadership. Therefore, health organisations should seek to invest in, better train and promote PCPs in leadership.