A Need For Leadership In Primary Care

This call to action appears as a commentary in the October 2009 issue of Association of American Medical Colleges.

According to lead author Jeffrey Markuns, MD, EdM, attending physician in the Department of Family Medicine at BMC and assistant professor of medicine at BUSM, to respond to the looming crisis in primary care staffing and leadership for community health centers, a call to action is needed that includes building integrated collaborations between academic medical centers and community health centers, creating a national program to provide training and mentorship for potential primary care physician leaders and identifying new funding mechanisms for medical education in community health centers.

Community health centers are cost effective in providing high-quality health care to the uninsured and underinsured populations while improving access to care and reducing health care disparities. Many previously uninsured patients have obtained health insurance, reducing the financial barriers to health care access. Coverage alone, however, has not resulted in universally improved access. A shortage of primary care providers has made access to primary care more difficult, and, as a result, emergency room utilization has increased.

Prompted by the mandate for universal coverage, community health centers intensified their efforts to provide access that otherwise would be unavailable through overtaxed primary care providers in the private sector. Community health centers already struggle with institutional and financial challenges. These challenges worsen when the demand for services increases in response to expanded health coverage.

The quality of physician leadership plays a key role in the success of community health centers and their ability to make improvements and overcome their daily challenges. Conducting individual interviews and focus groups with local medical directors, the BMC/BUSM researchers found that many new medical directors enter their positions poorly trained in leadership skills, particularly as they relate to primary care in underserved settings.

"A direct correlation exists between the degree of success in achieving institutional improvements and the degree of prior leadership training," said Markuns. "Medical directors with substantial training and mentorship experience greater satisfaction and display a greater ability to achieve essential improvements. Those without sufficient leadership training struggle and often fail to accomplish meaningful and important changes in their institutions. This often results in rapid turnover in the medical director position, adding to the challenges faced by community health centers.

"Universal health coverage is an ethical and practical necessity for our nation that will provide benefits to individuals, employers, and our nation's economy. To achieve universal access to health care, more than financing and health insurance reform is needed."