Smoky Hill residency teaches the young doctors to avoid micromanaging and encourages delegating responsibility to staff, which is crucial to the success of the medical home. McGeeney says a competent physician assistant can increase per-physician capacity by at least 20 patients a day, but only under a team concept. If the physician is checking temperatures and blood pressure and doing the paperwork instead of delegating to a physician assistant or an office administrator, that reduces the number of patients who can be seen, reduces patients' face time with their physician, and defeats the purpose of the medical home.
"When I trained in the '70s it was more 'captain of the ship' mentality," McGeeney says. "Now we need physicians to be more comfortable working with nurse practitioners and physician assistants and allowing them to do what they go to school for. We're urging physicians to practice in an environment where the patients participate in the decisions, so you work with patients and not just talk at them."
McGeeney and Kellerman carry a missionary's zeal for medical homes, particularly in the age of medical subspecialties, where the product of medical schools isn't meeting the needs of the greater society. "It's probably healthcare in America's only hope at this point," McGeeney says. "I do strongly believe the healthcare system in this country needs a strong primary care base. We know specialty care by itself is costly and fragmented and we absolutely need it but one of the big concepts of medical home is somebody coordinating the care."
Kellerman says he believes the medical home is here to stay because it's the only model that addresses the pressures facing healthcare delivery now and in the foreseeable future, particularly access. "In 20 years we are going to look at the way we've been treating patients now and we are going to disbelieve that we did it this way," he says. "No EMR, no registries, no emphasis on taking care of chronic illness and preventive care, with group visits and working as a team. I don't think it's going to be a flash in the pan."