Glimpse the future of primary health care

About 65 million Americans live in communities with a shortage of primary care doctors, physicians trained to meet the majority of patients' health care needs over the course of their lives.

How much more difficult will finding a primary care doctor become as a result of the recently passed health care reform legislation, which will extend coverage to an estimated 34 million currently uninsured Americans by 2019?

Massachusetts, which in 2006 passed a law that led to nearly universal coverage of its 6.6 million residents, might provide some clues.

In that state, fewer and fewer internists and family practice doctors are taking new patients, and wait times to see family practice doctors are lengthening, according to the Massachusetts Medical Society and the non-profit Massachusetts Health Quality Partners.

Even before Congress in March passed the landmark law designed to make health care more affordable and expand coverage, an aging population and doctors' increasing preference for higher-paying specialties set the stage for a primary care shortage. And what many believe to be an outdated reimbursement system — one that drives doctors to schedule office visits when a quick phone call or e-mail might do — doesn't help.

The shortage of primary care doctors could lead to longer waits not only for primary care, but also for specialty care as well as greater use of expensive emergency rooms for non-emergencies, researcher Walt Zywiak of Computer Sciences Corp., an international consulting company headquartered in Falls Church, Va., noted in a July report.

But some innovative programs provide a glimpse of what the future of primary care — a future in which a one-on-one visit at the doctor's office takes a back seat — could look like. They include:

A Portland, Ore., practice where doctors provide more care via the phone or e-mail than face-to-face.

A Massachusetts practice that offers "shared medical appointments" for six to 14 patients.

A Philadelphia clinic in which nurse practitioners, who have earned master's or doctorate degrees and have trained in the diagnosis and management of health problems, provide primary care.

Better communication

GreenField Health, founded in Portland in 2001, gets its name from a Harvard Business Review article in the early 1970s, chief operating officer Steve Rallison says. If you could create a business from scratch, it said, you'd start with a green field.