I Am a Primary Care Champion

New Feature Republished from the July 2020 Executive Member Update (monthly e-newsletter)

This Q&A is republished from the July 2020 Executive Member Update (monthly e-newsletter). It is a new feature of the newsletter. Each issue includes a short profile of an individual who works in primary care. It is a way of recognizing the dedication and passion that clinicians, advocates, and others have for primary care and connecting readers of the newsletter to people like them.

L. Allen Dobson Jr., MD FAAFP, who retired in late June as CEO of Community Care of North Carolina

Why are you passionate about primary care?

Having been a family physician in the same small town for over 30 years, I can say that primary care is and should be the foundation of the healthcare system. The importance of having access to primary care in every community, whether a small town or just a neighborhood in an urban area, goes beyond just the comprehensive care offered and the continuity and personal relationship with patients over time. Primary care also extends itself into the community in the form of local leadership and community economic benefits. 

If you had a magic wand that you could wave to change one thing in primary care, what would it be?

We have discussed nationally the value of primary care and the need for a new payment model for over a decade. The evidence is clear. Yet we have spent more energy on trying to reinvent primary care and introduce complex new payment rules than addressing the core issues. What if the solution to many of our healthcare and disparity issues were as simple as a national, collective movement to fix the payment system for primary care away from the FFS system and to pay primary care more, concentrate on training and placing primary in every community and let them do what they are trained to do? My fear is that we are becoming more consolidated but also more fragmented and moving away from what we know works.

What one thing about your work do you want people working outside primary care to know or understand?

I would say that primary care is hard but is so very important to the health of our communities in the U.S. It is deeply personal and built upon relationships. While technology can make it work better, it is not a replacement. Our experience has also shown us that even with the greatest clinical innovations, you need to be flexible because every community is different. How best to implement broad scale clinical efforts requires patience and flexibility.

Looking back on your career, what’s the most significant contribution to primary care that you or your team have made?

I am most proud of two areas of work, which have allowed me to work alongside so many caring and talented healthcare professionals:

  1. Having the opportunity to create a new and innovative Family Medicine Residency program - Cabarrus Family Medicine Residency Program in N.C. - that has trained hundreds of new family physicians for rural and small-town practices; and
  2. Our work with Community Care of North Carolina over the last 20 years.

The idea when we started was to provide access to primary care to every Medicaid patient in N.C., one of the earliest efforts defining the medical home. Then we wanted to support primary care with the needed resources to provide better care in the community. The results of improved quality and cost savings over the years providing care for over 1.5 million Medicaid patients in every community of N.C. has been well-documented. Our collective innovation around care coordination, mental health integration, partnership with community pharmacists, smart use of data analytics and community partnerships have been very rewarding, and I think have helped shape the national dialogue.

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