"Tragedy of the Commons" vs the "Joy of the Surge"

Steve Ornstein, the founder of PPRNET, in a recent post to PPRNET members mentioned the "tragedy of the commons".  I remember reading about this some time ago so I had a chance to refresh my memory and will now share with you what our shared dilemma is today.   After our practice recently attended the PPRNET network meeting August 25-27 in Charleston, I wanted to reflect on the purpose of PPRNET and how it helps practices AND contributes to meaningful research.

Again, participating with this great organization for the past 21 years, I was reminded how PPRNET truly helps our practice improve the care of our patients.  The whole process (including participating with the research) has helped our practice culture and made a positive difference in our bottom line of quality and financial success.  But now a few moments on the "tragedy of the commons" vs. the joy of the surge..

The tragedy of the commons is a situation where there is overconsumption of a particular product / service because rational individual decisions lead to an outcome that is damaging to the overall social welfare.

The tragedy of the commons theory assumes that when making decisions, people take the course of action that maximizes their own utility. However, if many people seek to do this, the net effect may be to deplete a resource making everyone worse off in the long run.

The tragedy of the commons was first observed in an area of common grazing land. Villagers all took their cows to this common grazing land, but this led to overgrazing and a loss of the resource.

A more modern example is that of over-fishing. Individual fisherman have an incentive to catch as many fish as possible. However, if many fisherman have this same motive, then it can lead to fish stocks being depleted as fish are caught at a faster rate than they are replenished.

Unchecked, this can lead to a collapse in fish stocks due to over-fishing.

If one individual fisherman holds back on his catch to try and preserve overall fish stocks, it may prove futile because many other fisherman continue to catch as much as possible. The net result is that fisherman don’t have any incentive to hold back, so they might as well try and catch as much as possible.

How does this apply to PPRNET? 

At this time, it is a perfect opportunity for PPRNET and its members.

PPRNET has had success in obtaining grants and funding to do really meaningful research.  The staff has been successful in getting funding on Health IT overuse, CKD, Alcohol screen/intervention, and medication safety.  Other research opportunities exist but PPRNET is could expand the positive effects of its research with practice participation.  

It is great that the PPRNET has had all this success but here is where the tragedy of the commons comes into play.  Each grant (using the fishing analogy) represents another fisherman fishing the limited population (the committed group of practices available to help participate).

The number of practice who currently participate, while committed, can only add so many more practice based research initiates at the practice level.  The population of fish (the practices) is thereby becoming the limiting factor.

How do you overcome the tragedy of the commons for PPRNET?  Here is where we need your help:

1) Increase the patients and practices who are members of PPRNET that participate.  There are some practices who are comfortable just receiving the quarterly reports and not participating in the research.  However, to them I would state the following: You may feel is stressed by all the challenges of today's practice of medicine and the changes in our medical culture.  I've found that if anything, PPRNET has actually continued to invigorate our clinicians but also the staff.  We've found that there are actually more opportunities to grow our practice financially as a result of participating with the research.  We've learned by interacting with PPRNET users at the network meetings and using the TRIP model (Translating Research Into Practice) as implemented through PPRNET during the studies.  Our patients and our practice are better of for it.  Participate... you'll be glad you did.

2) Increase the actual number of practices that do sign up with PPRNET.  PPRNET is now "EHR agnostic" which means that PPRNET no longer just extracts and compiles the information from the Practice Partner line of products (incluinding Lytec and Medisoft).  Other EHRs now also participate such as MDSuite, Greenway, Cerner, and Allscripts.  I know they are working on other EHR's also.  Talk up PPRNET with your colleagues who may be using other EHR's.  It doesn't hurt for them to contact PPRNET.

3) PPRNET is a QCDR (a federally qualified clinical data registry) - in 2015 they became able to submit PQRS data on behalf of participating practices.  Now, with MACRA on the immediate horizon, the quality measures will be able to be submitted by PPRNET to CMS on your behalf.  If you are a small practice, this is a BIG DEAL.  Additionally, those practices who are control or intervention practices with the Million Hearts Cardiovascular Disease Model will be able to have PPRNET submit this data through the PPRNET QCDR method.

This is meaningful research (my choice of 'meaningful' is purposeful here).  PPRNET makes a difference in our practice, our patients, the 2 million plus patients of the practices that participate and, as has been mentioned, nationally. 

SO... Please contact PPRNET as soon as you can

Medical University of South Carolina
Department of Family Medicine
5 Charleston Center, Suite 263
MSC 192
Charleston, SC 29425
Phone 843-876-1212 Fax 843-876-1211

Or to the website at

Make a difference ... and of course... increase the population of fish!

Turn the "TRAGEDY of the COMMONS" into the

JOY of the SURGE (of participation)

You'll be glad you joined.



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