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(HealthNewsDigest.com) – When illness strikes, there’s little more comforting than having a primary care physician who knows you and your family well and can help you through the maze of sub-specialists rapidly and efficiently. Yet that doctor might not be there for you when the need arises because of the decreasing number of primary care physicians.
To be affordable, a healthcare system must be comprised of 50-60% primary care doctors (internists, family physicians and pediatricians). Without this ratio, healthcare costs rise by more than one-third, as patients use the more expensive sub-specialists for simple problems and have nobody to coordinate their care or provide preventive services. A person who gets regular checkups is less likely to develop serious conditions down the road. Considering that 75 percent of health care expenditures go toward treating chronic illnesses, primary care is critical.
The system works most efficiently, and patients are happiest and most comforted with a generalist coordinating care. Once you’ve found a primary care doctor with whom you can communicate well, and whom you trust, you’re well on your way toward reliable and efficient healthcare: you get referrals to specialists highly regarded in their fields, whose bedside manner is similar to that of your primary doctor and who communicate rapidly with your doctor so that your care is well-coordinated and “the left hand always knows what the right hand is doing.”
The central proposals in pending healthcare reform will bring more uninsured Americans into the fold, but it won’t create more primary care doctors to treat them. Take the 46 million newly insured, add in an aging baby boomer population, and you could very well have a recipe for disaster.
Although the healthy 60% primary care objectives were met in the first part of the last century, the number of generalists has been shrinking – now only a little over 30% of practicing physicians are such generalists, and fewer than 3% of this year’s medical school graduates plan to make careers in primary care. Why the change in distribution? The answer is mostly financial. In the last several decades, medical reimbursements have been based on “doing something measurable” – specifically providing procedures such as surgery, colonoscopies and x-rays. A generalist, however, spends the majority of professional time face to face with patients listening, teaching, examining, thinking, explaining, sitting on the telephone coordinating care with sub-specialists and family and social services and insurance companies – time that is very poorly reimbursed by those insurance companies. For this reason, primary care physicians are the most poorly paid doctors in the United States – hardly an inducement to medical students graduating with (on average) $200,000 of debt, and the reason that many practicing primary care doctors are retiring early. The situation will be even more critical in January, 2010, when Medicare (the federal healthcare program for seniors) reduces its fees by 21%!
How might healthcare reform return primary care to its rightful place in this country and optimize the use of limited healthcare dollars? Organizations representing primary care physicians, including the American College of Physicians, The American Academy of Pediatrics and the American Academy of Family Physicians, have long proposed the concept of a “patient-centered medical home” – with healthcare centered on primary care. Studies have consistently shown that having a medical home was associated with better access to care, more preventive screenings, higher quality of care, and fewer racial and ethnic disparities.
Although President Obama has repeatedly offered support to the concept of a medical home, the question remains: will Congress and the President fund this concept, reward its providers appropriately, and make it a reality? You’re a voter: Make it happen!
“Reform will bring more uninsured Americans into the fold, but it won’t create more doctors to treat them,” said Velazquez. “Take the 46 million newly insured, add in an aging baby boomer population, and you could very well have a recipe for disaster.”
Velazquez described primary care as “an effective means for reigning in costs.”
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