Doctors hope patient-centered care model can salve N.J.’s distressed primary-care providers

Dwindling numbers of state medical school graduates are staying to practice primary care in New Jersey, and one organization fears the Garden State will see a “significant shortage” of family physicians before 2025.

Dwindling numbers of state medical school graduates are staying to practice primary care in New Jersey, and one organization fears the Garden State will see a “significant shortage” of family physicians before 2025.

Dr. Alfred Tallia, chair of the department of family medicine and community health at Robert Wood Johnson Medical School, said New Jersey is in the bottom five states for primary practitioners-to-population ratio.

“We’ve known for a number of years that part of our cost and quality problem in New Jersey is directly related to the relative absence of primary care,” Tallia said. “A large part of this has been driven by reimbursement, and this is a pretty expensive state to practice medicine. Most of the primary-care practices in the state are organized as small businesses.”

The costs of practicing family medicine in New Jersey have driven recent medical school graduates to focus on sub-specialties, and those who do study primary care tend to practice out of state.

Earlier this week, the American Academy of Family Physicians called New Jersey a “distressed practice environment”; in response to the designation, the New Jersey chapter of the association is sending Dr. Richard Corson, former president of the organization and delegate to the national organization, to a legislative conference in Salt Lake City on Friday. Corson, whose practice is in Hillsborough, said he’s going to the conference to discuss with family practitioners from other states to brainstorm solutions, legislative and otherwise, to the drought of primary-care doctors.

“Our main issue is this distressed practice environment, and right now New Jersey is in the spotlight,” he said. “But our feeling is that this is going to spread to other states unless more attention is paid to it.”

Tallia said his staff at RWJ is emphasizing primary care to the state’s medical students, and said innovative payment and practice models will eventually lead to a greater stability in the state’s primary practices.

“We have developed new models of care we’ve promoted and studied, for instance, around the patient-centered medical home,” Tallia said. “But the problem we have is in New Jersey … there really haven’t been the reform around payment that has helped promote these new models.”

The PCMH model, which Corson said he’s implementing in his practice and has won support from the state’s largest insurer, involves compensating doctors for keeping patients healthy, not for merely performing tests. But Tallia said the model is “still considered an experiment in New Jersey” despite its successful implementation elsewhere.

In addition to transitioning payment models, Corson said, a barrier to solving the primary-care problem is the cost of transforming a practice.

PCMH is “the way medicine needs to be practiced in the future, in the near future,” Corson said. “I don’t know that it helps the distressed practice environment at the moment, because it requires a lot of resources … it’s almost another stressor on New Jersey physicians.”

But Corson said he believes that new models of running a practice will attract more graduates from the medical schools than traditional fee-for-service practices.