Structural Issues

The body fixes itself, and the goal of the physician should be to abet this process, said Victor Sierpina, MD, from the University of Texas Medical Branch in Galveston. "We need to be out where people are, changing their lifestyles" so that the harm is stopped and healing can proceed.

But the current "find it and fix it" mentality has resulted in a reimbursement system that rewards more therapy, not spending time with patients to assist the body in healing itself, he said.

In most countries "the ratio of primary to specialty care [physicians] is roughly 3:1; in the United States, the pyramid is inverted, we have 60% specialists, 40% primary care doctors," Dr. Sierpina said. And the problem will get worse because fewer than 5% of medical school students choose primary care as their specialty.

Primary care also needs a major structural redesign, said Emory University's Kenneth Thorpe, PhD. Some "83% of primary care practices are in groups of 1 or 2, and they account for about 40% of primary care capacity." They also are the segment of providers least likely to have electronic medical records systems in place.

Dr. Thorpe said that the health system needs to find ways to better integrate these primary care physicians into the team approach to medicine and the continuity of care that the new health paradigm demands. Primary care physicians must gain the tools to better fulfill their role as coordinator of care. That is particularly true when one considers that 75% of current healthcare dollars go to treat chronic disease, not acute disease

Dr. Sierpina called for a change in reimbursement with some form of capitation, creation of time to spend with the patient, and creation of incentives for primary care. There was agreement that a resolution must address the burden of medical school debt and the status of primary care within the profession.

Dr. Snyderman said the model of physician-patient interaction will change. The physician-directed health team will serve more as a mentor to the patient, identifying the problem and offering guidance to turn it around.

A consensus seemed to emerge at the summit that the term "integrative medicine" may be a misnomer that mistakenly forces the issue into a clinical framework of disease. Rather the concept and language should be one of "integrative health," which embraces elements such as eating, exercise, and the built environment to foster health and allow the body to exercise its own healing functions.

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