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Cowart: There is plenty of room for diverse models in primary care


The Norman Rockwell view of the family doctor is not exactly the experience most of us face today. Our family physicians, pediatricians and OB/GYNs have for many years been the nation's front doors to health care.

As our society becomes more mobile and diverse, so has pluralism entered the venues of primary care. As our society becomes more mobile and diverse, so has pluralism entered the venues of primary care.

Integrated Models

Middle Tennessee is very familiar with this model, and Vanderbilt is a great example of an integrated delivery system. These are systems in which primary-care, specialty-care and inpatient and outpatient facilities are all combined into one organization. Vanderbilt clinics employ several hundred physicians. This is a substantial percentage of the primary-care physicians in Davidson and, especially, Williamson County.


New on the health-care horizon are the emerging models of retail primary care. CVS/Caremark Corp. has a national program known as the "Minute Clinic." Similarly, the Little Clinic has recently announced the relocation of its headquarters from Louisville, Ky., to Nashville.

The Little Clinic has a national contract with Publix food markets to place nurse practitioners and physicians in food stores. Finally, the Goliath of retail is Wal-Mart. Wal-Mart has long had significant initiatives in pharmacy and optical shops. Wal-Mart is expanding its physician and nurse practitioner programs throughout the country.

Micro clinics

Also hitting the landscape is the new concept of micro clinics. With the advent of Web-based technology, physicians can handle their own scheduling, pharmaceutical dispensation, as well as laboratory and other testing arrangements from a laptop computer.

With this possibility, some physicians are choosing the low overhead model and literally operating small, low-cost clinics out of storefronts without staff. As the physician revenue lines flatten, the low-cost model may increase in appeal.

Dental model

The final and perhaps most intriguing business model for primary care is that adopted by many successful dentists.

About 25 years ago, many of us had our dental work performed entirely by the dentist. Now, the dental hygienist does the cleaning and initial evaluation, thus leveraging the dentist's time for more complex and revenue intensive services.

The dentist's ability to leverage dental hygienists and dental technicians has resulted in many dental practices being significantly more profitable than the traditional primary-care physician's practices.

All health care begins at primary care. Access to care is determined by access to primary care. We should encourage the development of pluralist primary-care models with the ideal that one size does not fit all.

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