A Typology of Primary Care Workforce Innovations in the United States Since 2000

Abstract

Most conceptualizations of the primary care workforce described in the literature do not reflect the level of innovation needed to meet the needs of the burgeoning numbers of patients with complex health issues, the necessity for roles and identities of physicians to change, and the call for fundamentally redesigned practices. However, we identified 5 key workforce innovation concepts that emerged from the literature: team care, population focus, additional resource support, creating workforce connections, and role change.

Nurse practitioner and physician assistant staffing in the patient-centered medical homes in New York State

“…This practice redesign has resulted in a combination of transforming the roles of the existing staff and adding new staff to primary care (Friedman et al, 2014;Taylor, Machta, Meyers, Genevro, & Peikes, 2013). Consistent with the PCMH emphasis on care coordination, practices at times hired new staff, such as care managers/coordinators, who were not traditionally part of a primary care practice.…”

Disrupting the present to build a stronger health workforce for the future: a three-point agenda

“…Again, debates around this are ongoing, with various studies pointing to such a need. 9,28 Yet, trainers have largely failed to date, to transform curriculum design, despite the fact that, for the most part, they make an important and significant contribution in producing highly skilled and qualified graduates. A key question is whether traditionally separate training schools should be merged, with complete curriculum redesign and students naturally training together.…”

“…8 Mostly, the pointers are to multidisciplinary team work, shifting scopes of practice, differing professionals such as nurses taking on work traditionally performed by doctors, and emphasising different areas of training, such as medical generalists and hospitalists. 9 Alongside this, the challenges are routinely highlighted. These include maintaining a full complement of health professionals, sufficient to meet patient demand; of retaining professionals in a global marketplace that many, especially developing but also developed countries including the UK and New Zealand, struggle with; 10,11 and of ensuring that areas such as generalism and primary care are attractive professional choices when consultant speciality medicine is considered more prestigious and is ubiquitously better remunerated.…”

Maximizing the Patient-Centered Medical Home (PCMH) by Choosing Words Wisely

“…A review of the literature using 40 key terms to scan peer-reviewed material about workforce innovations in primary care in the United States since 2000 identified 331 relevant articles, from which investigators who had focused on workforce innovations were contacted and asked to nominate practices using a snowball sampling strategy. 18 Representatives from the practices on this list were interviewed in 2011 to 2012, and degree of innovation and sustainability in the practice was vetted by a team of researchers. From this list, we identified 19 practices with strong care teams and/or a population approach to care.…”