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March 04, 2010


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Kathleen Patton

I'm game. Let's envision.
During the dark and stormy nights of residency, I would ask myself, "Who's going to die first and what am I going to do about it." Plan for the worst case scenario, take steps to make it better. Maybe the future of medical care will not be as dystopian as we fear. Maybe because we are primary care, we don't want to think of the future without primary care.
Most would agree that the current non-system resembles a badly sutured Frankenstein's monster on the set of the film, Brazil.
So let's engage in speculation. Seriously. We need to start with some assumptions. I'll go first, beginning with bare bones.

—People will need medical/health care.
—Healthcare will need to be paid for.
—Health coverage is not healthcare, rather, one method of paying for healthcare

Your move.
Gordon, you in?

Jay Parkinson

That's absolutely correct Gordon and Kathleen. It's all about small pockets.

However, I'd like to envision what primary care looks like without primary care doctors running the show. I think that's the inevitable future for the next few decades/generations. So what would it look like? We're going to have to deal with this soon at the systemic level. Hmmmm.....

Kathleen Patton

I believe most of the movements in the course of human history began with 'small pockets' of change.

L Gordon Moore

Im totally with you on that Jay.

The renaissance of primary care can be found in the little pockets we see now. What you developed in Brooklyn with Hello Health, folks like Aaron Blackledge with CarePractice in SF, what Scott Shreeve is cooking up with Crossover Health in Orange County CA, Natalie Hodge with Personal Medicine and hundreds of colleagues who have opened their own ideal medical practices (see www.IMPMap.com remember to zoom in).

Were out here, were doing it, we have brave residents like Thuc Huynh planning to move fast into the next generation of primary care rather than try and shore up a broken system.

Well small but growing. Well show the way and encourage others to join our ranks in reinventing and reinvigorating primary care.

Jay Parkinson

Nice one Gordon. My only beef is this...when boomers retire, primary care dies. We need a 75% primary care/25% specialist workforce to make this happen in scale. With less than 5% of docs going into primary care for the past decade, with no signs of reversal in the millennials, we're 2 decades behind having a highly functioning primary care heavy system. And when Boomers retire or die, well, so does primary care.

That's not to say this isn't a good idea. It most certainly is...it'll just always be in little random pockets of America.

L Gordon Moore

True, true.
Ive got lots of energy but for now Ill stick to trying to fix health care. Maybe we can team up and you work on the public health federal subsidies for bad foods, etc.


I really enjoyed your amusing post!

In the end, however, the US needs to tackle the root causes of sickness: bad food, lack of exercise and stress. Reduce demand, reduce costs...

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