Author Affiliations: Division of General Medicine and Primary Care, Brigham & Women's Hospital (Drs Bitton and Frolkis), and Department of Health Care Policy, Harvard Medical School (Dr Bitton), Boston, Massachusetts.
We thank Dr Volpintesta for his comments on our Commentary.1 However, we respectfully disagree with a number of his assertions. First, he contends that “many primary care physicians already act as if they are PCMHs” and that this leads to job dissatisfaction. In fact, the current evidence about both the rather limited spread of patient-centered medical homes (PCMHs) across the United States to date2,3 and clearly improved health care provider experience within fully transformed PCMH clinics3 would suggest exactly the opposite. Second, he suggests that while primary care physicians will need to be paid extra income to accommodate increased responsibilities under the PCMH model, they would not be able to realize this income because of expanded team staffing. While it is true that upfront investment in PCMH team capacity through hiring of more staff and implementation of electronic health records will cost money, we would posit that this is an important, long-overdue, and even mandatory investment in primary care capacity during this rapidly emerging era of care accountability and cost-trend management. Furthermore, some early evidence suggests that primary care providers do not necessarily reduce their incomes once they transform; some have even seen their income grow under the PCMH model.2,4
Bitton A, Frolkis J. The Patient-Centered Medical Home: Friend or Foe?—Reply. Arch Intern Med. 2012;172(6):524-525. doi:10.1001/archinternmed.2012.42