Dr Charles North's "Time Capsule" Extracts for 22nd National Conference Breakout Sessions

 

Charles Q. North, MD, MS

Dr Charles North is a Senior Fellow of the National Consortium on Community-Based Medical Education, the community of participants in the National Conferences on Primary Health Care Access. Dr North has retired friom the Indian Health Service, and is presently a member of the faculty of the University of New Mexico School of Medicine.

Dr North has reviewed the “time capsule” consensus statement from the Seventh National Conference of 1996 (see Time Capsule: The Consensus Statement of the Seventh National Conference on Primary Health Care Access), and has extracted the following statements from that document for discussion at the Twenty-second National Conference of 2011:


A. Preamble

2. Health care problems often are linked to other fundamental societal problems, including poverty, unemployment, racial discrimination, and poor education. Ultimately, strategies for solving health care problems may require addressing other problems.

D. Family and Community Medicine

1. One of the national health priorities, formally recognized in the mid-1960s, is that every person should have access to a personal physician, who has comprehensive training and the skills to provide continuous care to the individual and family. The reasons for establishing such a national priority remain as valid now as they were at the time.

G. Health Professions Education

2. The central mission of primary care educators must be the creation of a primary care workforce to meet regional and national needs. Public policy should be concerned with how the kinds of financing mechanisms needed to support that mission can be established or enhanced, and how adequate funding to meet that mission can be secured.

15. First year residency positions should be capped at 110% of the graduating medical students in a 50% generalist, 50% subspecialty mix.

20. Health professions education should be financed in part through mechanisms that pay the cost of the student’s education in exchange for public service obligations in underserved inner city, rural or other areas of need. In any emerging funding structure directed to health care reform, meaningful all payor contributions to the funding of primary care education in ambulatory settings is necessary in both predoctoral and graduate education.

26. Physician residency programs should take a proactive role in the placement of physicians in underserved communities, including political support of service corps programs. A placement service for such communities should be instituted by medical schools, where appropriate.

H. Health Promotion

3. The monitoring of quality and outcomes should include the evaluation of access to and effectiveness of primary health care services. “Healthy People 2000? objectives should be incorporated into quality measures for such monitoring activities.

J. Reimbursement

Reimbursement should continue to move towards prospective payment at an overall fixed amount for providers and plans. Providers and plans should be held accountable for prospective budgets and allocation of resources that maximize access, efficiency and quality.

L. Teaching Community Health Centers

2. Teaching Community Health Centers [TCHCs] are a model for community-based service, education, and research. These TCHCs are expected to improve the quality and outcomes of health professions education by integrating medical education within model community-oriented primary care practices operating in a reformed health care delivery system.

13. Changes should be made in federal and state statutes and regulations that accomplish the following:

a) TCHCs should be eligible to directly receive graduate medical education payments that reimburse these centers for their development and      operational costs.

b) startup funds for planning and development of TCHCs should be identified and made available.

c) TCHCs will be recognized separately from non-teaching community health centers by taking into account the special needs of ambulatory-based    teaching programa.

d) the National Institutes of Health, Agency for Health Care Policy Research, and other federal research agencies should increase their focus on  primary care research by utilizing TCHCs.

e) faculty development, technical assisstance, and support programs for TCHCs should be developed and implemented.

f) loan repayment programs serving medically underserved communities should target residents and faculty of TCHCs.

O. Rural health

2. Public funding of health professional education should be based, in part, on how well this education meets the provider needs of the region. The ultimate success is the number of graduates who practice in specialties and geographic locations of need.

Q. Rural health systems

5. Mental health services and long-term care facilities in rural communities hsould be integrated effectively into the health care systems.

U. Coalition building

7.The goals of coalitions to further access to primary care are: a) developing rational, effective primary care delivery systems responsive to clients, their families and communities; b) enhancing the biopsychosocial education and training of primary care health professionals, including team training; c) developing the primary care research base in health services delivery, clinical outcomes, and training and evaluation methods; and d) reforming health policy and financing systems to reestablish the central role of primary care and to provide adequate service delivery to all our citizens.

16. Nationally, primary care organizations must develop an effective and singular voice on health policy and financing reform. At all levels they should become more effective at presenting the message that primary care is essential to the future health of the nation and can only be provided in a quality fashion by those who are trained and specialize in it. This message must be successfully conveyed to our citizens and our political decision-makers

V. Personal values

1. Certain core personal values (“guiding principles”) are linked closely to effective primary care. Medical trainees choosing primary care specialties tend to rate benevolent personal values (helpfulness, honesty, loyalty and service) significantly higher than trainees choosing non-primary care specialties. Conversely, many subspecialists rate power values (wealth, social standing) significantly higher.