5 Keys to Home-Based Primary Care Success
Ask the HBPC Experts: An interview with Tom Cornwell, MD and Paul Chiang, MD
When thinking about potential medical career opportunities, it’s natural to visualize yourself in a practice setting. It can help determine if the position is a good fit. But when it comes to practicing as a home-based primary care (HBPC) provider, it can be difficult to envision yourself in this role if you haven’t worked in the field before. What’s it like to have your office environment change on a daily basis? How would you approach patient care? What does it take to be successful in the field?
For insight into what makes an HBPC provider successful, we called on our in-house experts, Tom Cornwell, MD, Chief Executive Officer of Home Centered Care Institute (HCCI) and Paul Chiang, MD, Chief Medical Officer of HCCI. Both have worked as practicing home-based primary care physicians for years, collectively making over 64,000 house calls.
What did these experts have to say about keys to success in the unique, ever-changing field of HPBC? Read on to learn if you see a little of yourself in their answers.
Comfort with the Complex
As a primary care provider, you are trained and knowledgeable in the diagnosis and treatment of a wide range of health issues. But in an office or clinic setting, you also have the resources to refer patients to a specialist when needed. When it comes to providing care in the home environment, you are the specialist.
“As a HBPC provider, you are often the patients’ total access to health care. Because they often cannot leave home for diagnosis or treatment, they look to you to handle everything,” explained Dr. Chiang.
This means that if a patient has advanced heart failure, requires a ventilator, battles after depression or is newly diagnosed with diabetes, the HBPC provider plans treatment and provides complete care.
“Those who work in home-based primary care need to be comfortable taking on this level of complexity and finding the answers when necessary,” said Dr. Cornwell. “No one is expected to know everything. But a good HBPC provider researches, ask a lot of questions and is willing to help in whatever way is needed. Remember, the greater the challenge the greater the reward.”
Flexibility
Typically, primary care providers are accustomed to working in the sterile, organized and often predictable environment of a health care office or clinic. But when an HBPC provider goes into the home, he or she must be comfortable giving up control over their working environment.
“As an HBPC provider, you might encounter strong odors, pets and messy spaces in the home. You might have to adapt to weather or traffic issues on the way to see patients,” said Dr. Chiang. “The key is to be adaptable. Not everything is under your control, and you need to be comfortable with that.”
Although the HBPC environment may be out of the ordinary and sometimes out of your comfort zone, Dr. Cornwell adds it can aid in your ability to care for the patient.
“When patients come to an office setting, they typically present their best for the appointment,” he explained. “However, in the home, you see them as they are on a daily basis and can observe their surroundings for clues to their health and wellbeing.”
For example, uncleanliness, lack of food in the refrigerator or problems with running water can contribute to health issues or prevent effective treatment. Learning to observe and identify potential problems in the home can help you provide even better care.
Ability to Relate
Compared to a typical health care environment, HBPC providers get to know their patients intimately – they meet their families, understand their home life and have time to get to know them. Care and treatment also accompany conversation and compassion. For some, this is one of the most rewarding and enriching parts of the job.
“Being at a patient’s home, I have the unique opportunity to learn more about the patient not just medically, but about the patient’s family, hobby, work history, and other interesting stories from his or her past. This personal experience encourages me to look at my patient beyond just his or her illness, but as a fellow human being with many similar desires and needs. Home visits enrich you in both professional and personal ways that are difficult to match in other medical settings, explained,” explained Dr. Chiang.
He continued, “Home-based primary care puts the humanness back into medicine – it’s why most of us are drawn to the health care field in the first place.”
Because the role of the HBPC provider is so personal, it’s important to be able to easily connect with others, enjoy learning about other experiences and perspectives and have a lot of patience. These traits can not only make the job enjoyable but improve patient outcomes and care.
“If you cannot develop a good relationship with the patient or their loved ones, they are less apt to listen to your guidance or receive follow-up care,” advised Dr. Cornwell. “More than in other health care settings, your ability and desire to relate to patients can make a big impact on your success.”
Willingness to Set Limits
Because of the unique, personal relationships often developed with patients, HBPC providers may feel compelled to stretch the boundaries of medical care. This is especially true when a provider notices a real need that can affect their patient’s health and wellbeing. For example, perhaps a patient is having difficulty picking up medication, needs meals delivered to the home or is having trouble paying bills. When this happens, it can be difficult not to get pulled outside your scope of work.
“You get to know patients and want to help them in any way you can. But it’s very important to set limits,” said Dr. Chiang. “As a HBPC provider, you must learn to say no when appropriate but be willing to direct them to resources that can help.”
Dr. Cornwell adds, “Over time, providers will develop extensive knowledge about community resources – from social workers, transportation companies, and agencies for the aging – that can fill in some of the gaps for patients. By referring to other resources, you can help patients without overstepping your role.”
Both physicians advise providers to be compassionate and firm.
“I tell my patients it’s because I care for their wellbeing and the wellbeing of others that I do house calls, but I can’t do everything for them,” said Dr. Cornwell. “Taking on too much social needs can detract from medical care and lead to burnout.”
An Independent Spirit
The work of an HBPC provider takes independence – not to mention problem-solving, creativity and competence – in some different areas. For example, a provider may wear multiple “hats” on any given day – from cardiologist or pulmonologist to gerontologist and everything in-between. He or she must learn how to use mobile technology to conduct in-home EKGs and other tests. And there is often the need to sit down and have a conversation with patients and loves ones about goals of care and end of life choices.
In short, there is no one-size-fits-all day in the life of a HBPC provider. And there is no one-size-fits-all provider. Providers come from all backgrounds – from nurse practitioners, physician assistants, primary care providers and hospitalists to students looking to use their education to make a bigger difference.
Regardless of where HBPC providers come from or what they encounter each day, pursuing their work with independence and confidence is key. They need to be comfortable finding answers when necessary and using them to create and follow a plan of care that focuses on meeting the goals of the patient. And that’s exactly what most HBPC providers love about the job.
“You are fully in charge of your patient’s care,” said Dr. Cornwell. “If you want to make a difference in medicine, this could be the right place for you.”
The Bottom Line
Drs. Chiang and Cornwell have had years of experience honing their skills in home-based primary care. But no one enters the field with everything they need to succeed. That’s why HCCI has developed an education and training program to help you develop the knowledge and practical skills to practice home-based primary care. It also provides hands-on experience in the field so you can not only envision yourself on the job but experience it firsthand.
If you’re looking to sharpen your skills or are considering a career in home-based primary care you can call us at 630-283-9210 to talk with someone about how we can help you can become an HCCI trained HBPC provider.
A research team consisting of Aaron Yao, PhD, of the University of Virginia School of Medicine, Christine Ritchie, MD, of the University of California, San Francisco; Bruce Leff, MD, of Johns Hopkins University and Thomas Cornwell, MD, of the Home Centered Care Institute (HCCI) have recently published a study in the Journal of the American Geriatrics Society that found frail seniors are going without desperately needed in-home healthcare.
