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Shared Values In Primary Care

This post originally appeard on PrimaryCareProgress.org.

The Josiah Macy Jr. Foundation has helped make possible some of PCP’s most important initiatives, including the Gregg Stracks Leadership Summit and the student hotspotting project. We sat down with President Dr. George Thibault of the foundation to discuss the need for improved primary care education and the importance of interprofessional teamwork and learning to care for the underserved—among our many other shared values. See what Dr. Thibault had to say.

Progress Notes: Like Primary Care Progress, the Macy Foundation values interprofessional education and interprofessional teamwork among health care professionals. Why is that? Is there a benefit for patients, professionals or both?

George Thibault: We have growing evidence that health care delivered by well-functioning teams leads to better outcomes for patients. Until recently, our education process has lagged behind that. We’ve educated our health professionals separately from each other. But the educational process should be interprofessional from the beginning as well. So that’s one of the things we’re trying to change.

Part of the experience for all health professions students during their training should be to develop a greater appreciation of what other health professionals do and a greater appreciation of the importance of working in teams. One of the core competencies for all health professionals should be the ability to work in teams, which we know can be taught and assessed. We believe that it’s an important part of preparing people for a career in which they’ll be working in teams. It also leads to greater professional satisfaction and avoids some of the negative aspects, such as burnout, that have been cited as reasons why people don’t go into primary care. Well-functioning teams lead to better patient outcomes, better patient satisfaction and greater professional satisfaction.

The goal is to have every member of the team functioning at the highest level of their training. That’s true of doctors, nurses, pharmacists and everybody on the team. If you’re making maximum use of everybody, then the whole team is functioning better and everyone is individually satisfied as well.

PN: The Macy Foundation also values improving primary care education and caring for the underserved. What kind of training should health care professionals, students and trainees all receive about these topics?

GT: In addition to interprofessional education, more education needs to occur in settings in which people are receiving care. Acute care institutions, where care is enormously valuable and an important part of our health care system, are still disproportionately represented in education. A larger part of the education experience needs to be in the community setting and outpatient setting.

By giving learners those experiences in those settings, we build up their confidence and comfort to ultimately practice in those settings. That includes having educational experiences in rural settings and inner-city settings. The Macy Foundation has promoted programs that sponsor a more community-based approach to physician education. We have also promoted more intense longitudinal experiences to promote careers for people who are interested in practicing in various settings. If learners don’t ever see those settings, it’s unlikely that they’re going to choose them and unlikely that they’ll be comfortable in them. We also believe that not everybody should have the same experiences. The experiences should be more tailored to what the student’s career objectives are.

PN: PCP has received grant support from the Macy Foundation for the Gregg Stracks Leadership Summit and the hotspotting program. What is it about PCP’s work that has encouraged the Macy Foundation to invest?

GT: PCP plays a valuable role in calling attention to the importance of primary care and advocating for careers in primary care. That’s important for attracting the next generation of health professionals — not just physicians but other health professionals who want to be part of primary care teams that address patients’ needs.

We still do not have enough primary care providers, and PCP’s programs are an important piece of changing that. This includes advocacy work and leadership training. It means validating decisions people make about why they’re getting into primary care and finding kindred spirits to spend time with. It requires working on improving models of care so they’re better for patients and health professionals. I’m impressed with the energy that has been brought to the work that PCP is doing and how it has become a national movement. We haven’t solved all the problems yet, but we’re making a dent.

George E. Thibault, M.D., is the seventh president of the Josiah Macy Jr. Foundation. Prior to his current position, he served as Vice President of Clinical Affairs at Partners HealthCare System in Boston and as Director of the Academy at Harvard Medical School (HMS). For nearly four decades at HMS, Dr. Thibault held leadership roles in many aspects of undergraduate and graduate medical education.

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