Primary Care Physicians...Who You’re Gonna Call
By Ronald Musto MD, MPH
In the 1976 television drama, Marcus Welby M.D., actor Robert Young epitomized the wise and kindly doctor who provided comfort and cure with only a smile and a stethoscope. In many ways the field of medicine has changed profoundly since the 70’s. Technologies and treatments abound. Medical knowledge has grow rapidly and is disseminated as quickly on social networks as it is in medical journals – sometimes faster. The nation spends 16% of its income on healthcare. Yet, the essential interaction between physician and patient – that Marcus Welby moment – remains a cornerstone of what has come to be known as primary care.
Who are Primary Care Physicians?
The National Ambulatory Medical Care Survey describes primary care physicians as personal care physicians who provide preventive and diagnostic services, counseling and education on healthy behaviors, management and coordination of care, and facilitation of access to specialty care. More simply, your primary care physician is your first stop for maintaining good health. Specialties that are traditionally characterized as primary care practices include family medicine, internal medicine, geriatrics (for the elderly), pediatrics (for children) and obstetrics/gynecology (for women).
Primary Care and Subspecialty Care – What’s the Difference?
Subspecialty services – both surgical and medical – are indispensable. They are, however, highly technical and narrowly focused. To navigate what is often a medical maze, people need a physician with broad enough expertise to diagnose medical conditions accurately and to expedite treatment including, when necessary, the participation of subspecialty physicians. Primary care physicians have the opportunity to develop long term relationships, allowing the physician greater understanding of their patients’ often complex medical and social circumstances. This provides the foundation for a holistic approach not only to disease management, but to disease prevention.
Why is Primary Care Important?
In the United States, six out of ten medical encounters, and nine out of ten preventive health visits, are between patients and primary care physicians. In these encounters, physicians address not only their patients’ immediate health problems but they evaluate all their patients’ health issues – past and future. They address health risk factor reduction, lifestyle modification, immunization, mental health issues and provide age and gender specific evidence based recommendations for healthy living. The outcome is better health at lower cost. Barbara Stanfield, Professor of Health Policy and Management at Johns Hopkins University writes, “Robust evidence shows that patient care delivered with a primary care orientation is associated with more effective, equitable and efficient health services”.
What Challenges Lie Ahead?
Primary care physicians are dwindling in number. In 1998, 52% of internal medicine residents entered primary care. In 2007, only 22% did so. The burden on those physicians who remain in primary care detracts from their professional and their personal quality of life. A reimbursement system that favors highly technical, procedure oriented subspecialties, together with the high cost operating within our complex, inconsistent and highly regulated medical industry is a further deterrent. The population is growing who live longer, but sicker with numerous, complex medical conditions.
Are there Solutions?
Forward looking medical practices, like Community Care Physicians, are placing primary care at the center of the growing trend to manage not only individual patients, but whole populations. Most of the proposed solutions by government and others to the U.S. health care “crisis” rely on this approach and have called it the “Patient Centered Medical Home (or PCMH for short)”. PCMH uses information technology in the form of electronic health records (or EHR) to make relevant information readily available at the point of service to any provider –primary or subspecialty- who participates in a patient’s care. Moreover, EHR expedites the analysis of patient population data so that the overall effectiveness of care can be measured and improved. Care delivery systems are being reexamined. Rather than relying upon single, often overworked primary care physicians, the PCMH uses teams of health care professionals including nurses, mid-level providers and educators to deliver appropriate services at appropriate times in an accessible and convenient manner.
Where Is Medicine Going?
Technology will continue to enhance our understanding and our capability but its application will be subject to more rigorous cost-benefit analysis. Medical care organizations will be held to higher standards of consistency in the application of evidence based care guidelines. Effective health care organizations will continuously adjust and improve their operations to provide more accessible, more efficient and more effective care to more people with more medical problems. But at the heart of the health care system will always remain the kind smile and, yes, even the stethoscope of the primary care physician.
Ronald V. Musto MD, MPH is a practicing internist and executive vice-president of Community Care Physicians, whose primary care practices earned recognition by the National Committee on Quality Assurance under their Physician Practice Connections-Patient Centered Medical Home program.
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