PRIMARY CARE: Alliance Prepares MDs for Managed Care
Yesterday's Washington Post profiled a three-year-old Georgetown University Medical Center-Kaiser Permanente program "designed to train primary care residents to practice high-quality medicine in managed care settings." Challenging years of convention that gave residents experience only in academic centers "barely penetrated" by managed care, the Georgetown/Kaiser pilot residency program is one of 66 set up by the Pew Charitable Trusts as part of a program called Partnerships for Quality Education. Residents divide their time between Georgetown University Medical Center and Kaiser's West End Center, a large outpatient center, learning cost-effective utilization of resources and other necessities of navigating managed care settings. At the conclusion of a six-month stint as a full-time doctor at an out-patient clinic, residents are evaluated based upon patient comments, immunization and screening test rates and an analysis of referral and drug-prescribing patterns.
A 1996 JAMA study found that it traditionally "takes one to two years of additional experience beyond residency for doctors to learn how to practice effectively in a managed care setting." The main problem is the logistical limitations of a teaching hospital: while 80% of internal medicine and pediatric residency training occurs in hospitals, 90% of a primary care physician's time is spent in a "fundamentally different" environment -- office or clinic. Pew program director Gordon Moore, a Harvard Medical School professor, said training residents in hospitals for office-based practice "is like training people to be foresters by having them work in a lumber yard. Most programs, even the most prestigious, are training residents for a world of medical practice that no longer exists" (Boodman, 2/2).