At a Crossroads: The Future of Primary Care Education and Practice.

Academic medical centers are under increasing scrutiny to provide both timely, high-quality primary care (PC) and health professional education. The complexity of these issues will require innovative multipronged solutions aimed at academic ambulatory PC training programs. In this issue, Serrao and Orlander describe one model that may address some of these issues: the Ambulatory Diagnostic and Treatment Center (ADTC) in the Veterans Affairs Boston Healthcare System. The ADTC model offers primary care providers (PCPs) the opportunity to refer an especially complex patient to a team of PC faculty and trainees who are not familiar with the patient but who have more time and resources to dedicate to her or his care. The ADTC is one model that may mitigate some of the tension between patient care and education in PC settings. Another model is the West Haven Veterans Affairs Center of Excellence in Primary Care Education program, in which interprofessional teams of faculty and trainees are assigned to care for a panel of patients. Creative solutions to overcoming the barriers to providing timely, high-quality care as well as a commitment to providing sufficient time and quality in PC education are essential. These solutions must include models of education and care that (1) preserve PCP-patient continuity, (2) allow more time for complex patient visits, and (3) integrate interprofessional teams to support PCPs. These models will afford patients, providers, and trainees sufficient time for patient care, continuous relationships, learning, and reflection, resulting in improved satisfaction and more meaningful work.