PCMH Residency Programs: Training the Future's Primary Care Physicians

Coordinated care delivery models have taken the healthcare industry by storm, with patient-centered medical homes and accountable care organizations becoming more popular with hospitals, health systems and large physician groups trying to provide high-quality care at a lower cost.

However, the number of primary care physicians is dwindling due to an aging workforce and fewer medical students going into the profession, yet primary care providers are essential to the success of coordinated care. Additionally, PCMH and ACO models have been around for less than 10 years, so not many physicians have experience providing care in these models.

"The national healthcare landscape really needs to change," says Bill Warning, MD, program director of Crozer-Keystone Family Medical Residency in Springfield, Pa. "And we can't do it without training the workforce."

Training the physicians of the future

In order to prepare the next generation of physicians to provide care in team-based care delivery models like patient-centered medical homes, some systems, such as Crozer-Keystone Health System, have established PCMH residency programs, where primary care residents are trained in a PCMH practice.

In 2009, the Center for Family Health, the home of Crozer-Keystone Family Medical Residency, was recognized by the National Committee for Quality Assurance as a Level 3 PCMH. "We developed the PCMH…mainly to train a new workforce," Dr. Warning says. "We believe this model of care is coming and felt the model of care we train [residents] for should mimic the model of care we believe in." 

Since the center's PCMH recognition, the nine residents that graduate each year spend three years immersed in a medical home and come out prepared to practice medicine in a team-based, patient-centered environment.

PCMH residency programs don't just help build the medical home model of care delivery — they also help support the ACO model, according to Richard Snyder, MD, CMO of Independence Blue Cross in Philadelphia. "We think it's very critical to rapidly transform the workforce, train young medical students in the [medical home] model to…support budding ACOs," he says.

That belief is why Independence Blue Cross supports PCMH residency programs like Crozer-Keystone's. "We provide tools so residency programs can transition to patient-centered medical homes," Dr. Snyder says. For instance, Independence Blue Cross supports Crozer-Keystone with data to help the system better manage the health of its populations. In return, the residency programs give the payor informed feedback, allowing it to expand its reports to PCMH physicians and strengthen the program.


About 35 residents have graduated from the Crozer-Keystone PCMH program since the practice started its transformation into a medical home in 2008.

According to Dr. Warning, the PCMH graduates are more likely to go on and join an already-established medical home. "The graduates leaving the program say, 'Now that I've graduated from a Level 3 PCMH, I want to join one,'" he says.

Further, PCMH residency grads can also provide guidance and experience to existing practices that are trying to become a NCQA-recognized PCMH. "They can change it from the bottom up," Dr. Warning says, helping spread the model to more physician practices.

Overall, PCMH residency programs, like Crozer-Keystone's, are training the next generation of physician leaders who can implement and improve PCMHs and support ACOs in order to transform healthcare.

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