The idea of a medical home has always been common sense for Family Physicians, but the Pediatricians rediscovered the idea a few years ago.
What really spurred the movement is the development of Patient Centered Medical Homes by IBM, for their employees. Dr. Paul Grundy has been working closely with the American Academy of Family Physicians on the project, in addition to the Internists, Pediatricians and other large employers.
http://www.ibm.com/ibm/ideasfromibm/us/healthcare/20081203/index.shtml
“”Remember your family doctor? The person who knew your whole history? Who would see you outside of office hours and on weekends? IBM and healthcare advocates want to bring the family doctor back... in the form of a new model for primary care: the Medical Home. And in this new world, he or she will even make house calls—albeit virtually.””
More:
http://www-03.ibm.com/industries/healthcare/us/detail/landing/Y195013I19184U48.html
The problem is that it is recognized that doctors are consider too “elite,” cost too much, and aren’t all that pliable. And then, Grassley and Baucus come from States that allow Nurse Practitioners independent practice.
I think that, more than pressure from the NP lobby, the real reason is that nurses are assumed to be cheaper and more pliable to regulation.
The thing to remember is that nurses have their own Board of Examiners (or the State equivalent) and are taught to practice *nursing,* not medicine.
I’m not quite sure what the difference is, but the one nurse practitioner student that I precepted in my office and the one nurse practitioner who had gone back to school for some reason to become a physician assistant, did not think about disease and treatment the way I do. It seemed more rote memorization and following a cookbook.
Now, I love cookbook medicine when it’s possible to know that there’s only one main recipe and which ingredients can be adjusted or substituted. But the medical diagnoses that fit under cook book protocols are few.
I’m probably chauvinistic about my profession compared to nurse practitioners. (And I do apologize often for the conduct of my fellow doctors.)