Linda Cronenwett Co-Chairs National Panel to Improve Quality & Delivery of Primary Care

The below press release was provided by the Josiah Macy, Jr. Foundation.

Diverse panel of HEALTH CARE Experts convened by Josiah Macy, Jr. Foundation urges Comprehensive primary care reform

Sweeping Recommendations Aim to Strengthen Primary Care through Greater Investment, Expanded Roles for Nurse Practitioners and Physician Assistants, New Care Models, Changes in Education, and Involvement of Academic Health Centers

New York, NY – A diverse panel of leaders from across the health care community – including allopathic and osteopathic physicians from academic and general practice settings, nursing professors and nurse practitioners, physician assistants, deans, academic health center executives, and representatives from health policy, government, and business – today said that nurse practitioners and physician assistants must have more authority to deliver primary care along with general physicians if the United States is to meet growing demands for such care.

The proposal is a key element of a set of recommendations developed by the panel that aim to create a robust primary care system in the U.S., with the workforce and infrastructure to support it.  Other recommendations call for creating incentives for more people to choose careers in primary care, reforming education and training of new providers, ensuring a strong primary care infrastructure, and increasing financial resources for primary care.

“Primary care should be the hub of our health care system, where acute illness is managed, chronic illness is managed, and care is coordinated across the board.  Unfortunately, we do not have nearly enough providers to do the job – nor will we, without expanding our primary care workforce,” said George E. Thibault, MD, president of the Josiah Macy, Jr. Foundation.  “We must address this problem immediately, regardless of whether national health reform legislation is enacted.”

The panel, co-chaired by a former nursing school dean and the CEO of an academic health care system, was convened earlier this year by the Macy Foundation, and included nearly 50 health care leaders and experts who agree that the time to act on primary care reform is now.  The Macy Foundation released the recommendations today.

“To my knowledge, this is the first time that such a diverse group of leaders has forged this kind of agreement on what needs to happen in primary care,” said panel co-chair Victor J. Dzau, MD, CEO of the Duke University Health System and James B. Duke Professor of Medicine and Chancellor for Health Affairs at Duke University.  “We hope that payers and policymakers at all levels, as well as academic health centers, will take these recommendations to heart and act on them quickly.  The need for change is urgent.”

The lack of a strong primary care system in the United States has had significant consequences for access, quality, continuity and cost of care.  Despite spending $2.3 trillion on health care in 2008, Americans are not nearly as healthy as they should be.  In fact, the U.S. lags behind many other countries on key measures of health and longevity.

Meanwhile, the nation’s primary care needs are escalating.  Between 2003 and 2023, overall chronic illness prevalence is expected to increase by 42 percent.  Yet some 65 million Americans live in areas where there are not enough primary care providers.

“The workforce issues are serious, and there is no simple ‘fix’,” said panel co-chair Linda Cronenwett, PhD, RN, professor and Dean Emeritus of the University of North Carolina at Chapel Hill School of Nursing.  “Unless trainees from all provider groups witness care being delivered by effective and efficient teams of primary care professionals who have the infrastructures to support patients, families, and communities to achieve goals for individual and population health, we will continue to produce fewer and fewer primary care providers.”

The recommendations from the Macy Foundation panel include:

  • State and federal policymakers must act to remove legal, regulatory, and reimbursement barriers that prevent nurse practitioners and physician assistants from providing primary care. Nurse practitioners and physician assistants should be empowered not only to provide primary care but to lead multi-disciplinary teams of primary care providers.
  • Government and private payers and academic medical centers must increase their investment in primary care. This will require rebalancing current resources to change how providers are reimbursed and to put more money into the tools and infrastructure needed to provide effective primary care, such as new health information technology systems.
  • Medical, nursing, and other health professions schools must educate students differently for careers in primary care. They should expose students early in their education to primary care, immerse them in community primary care practice settings, teach them to work in teams, and identify effective role models for them.
  • Schools must also work harder to attract more students into primary care. They should establish programs to diversify their student bodies – socioeconomically, racially, and geographically – and partner with government agencies and other organizations on scholarship and loan repayment programs for students choosing careers in primary care.
  • Greater involvement from academic health centers is also needed. Academic health centers must embrace new team-based primary care systems as part of their mission, and they must provide inter-professional leadership by developing and implementing effective delivery models for others to replicate.

Copies of the recommendations may be obtained by visiting

The Josiah Macy, Jr. Foundation is a privately endowed philanthropy located in the borough of Manhattan, New York City. The Foundation supports programs designed to improve the education of health professionals in the interest of the health of the public.


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