What is Primary Care?

“A patient’s main source for regular medical care, ideally providing continuity and integration of health care services. All family physicians, and many pediatricians and internists, practice primary care. The aims of primary care are to provide the patient with a broad spectrum of preventive and curative care over a period of time and to coordinate all the care that the patient receives.”

Includes team of health professionals: family medicine, internal medicine, nursing, NP, pediatrics, general ob/gyn, gerontology, community health, etc. 

Primary Care Providers are the front lines of healthcare
  • First point of contact with healthcare system
  • First to see depression, early signs of cancer, etc.
  • “The Quarterbacks of Healthcare”
  • In community of patient (facilitates access)

Roles can include:

  • Health promotion and maintenance
  • Disease prevention
  • Counseling
  • Patient Education
  • Diagnosing and treating acute/chronic illnesses
  • Advocates for patient in coordinating care
Why is Primary Care Important?
    • Health:
      • Increasing primary care providers (PCPs) → improve community health, decrease mortality rate
      • Adults who see PCP have 19% lower odds of premature death than if they only see specialists
        • Longer lives, healthier newborns, less heart disease, cancer, stroke
  • Cost to the Healthcare System and Individual:
    • Early detection saves money by preventing expensive medical emergencies
      • i.e., less $ to prescribe blood pressure meds than treat a heart attack
    • People who see PCP save 33% on healthcare
      • 60% of problems in ER could have been addressed by PCP
    • If everyone saw PCP → save US $67 billion every year
What is the Primary Care Crisis?

  • “By 2020, the US will face a deficit of up to 90,000 PCPs”
  • ⅕ Americans currently don’t have access to a PCP
    • Especially in rural areas
  • 1965: 70% doctors were PCPs, 30% specialists
    • Reversed now
  • Projected to get worse as PCPs retire and demand increasing
  • Too little time with patients, too many referrals, less listening, less relationship development, more expensive health care
Why are there so few PCPs?
  • Higher earning specialties attract more medical students
    • Not seen as prestigious in medical school environment
    • “Status “ specialties attract most talented students: orthopedics, dermatology, neurosurgery
  • Reimbursement system
    • PCPs don’t make much money with current insurance system
    • Have to “make it up with volume”
    • Not incentivized to spend time coordinating care
What are the benefits of being a PCP?
  • Personal, long-term  relationships with patients and families
  • Sense of community
  • First line of defense
  • Huge gaps in supply/demand→job security
  • Understand the whole person–not just a particular illness
  • Variety
  • Less likely to get sued
  • Opportunity for work-life balance
  • Article in the Atlantic: “Why I’m Becoming a Primary-Care Doctor”
What is the potential role of other types of providers?

“It is unrealistic to rely on the physician workforce alone to provide primary care”

  • Primary care nurse practitioners
    • Nurse practitioner quality of care is often just as good, or even better, than that of PCPs
    • Scope of practice limited by state laws
    • More likely to practice in rural areas
    • More likely to care for vulnerable populations
    • Lower cost of care
  • Many PCPs think that increasing NPs would impair quality of care
Medical Home Care Delivery Model: “Transform how primary care is organized and delivered”
  • Team-based practices can help ease burden and burnout (and cut costs)
  • Emphasis on coordinated care between different aspects of health system all under the same roof
    • Community support
    • Reimbursement for time spent coordinating care
  • Team of healthcare workers: physicians, APN, PAs, nurses, pharmacists, nutritionist, social worker, educators, care coordinators

“A patient-centered medical home provides a structure that enables clinicians to work with their patients. In this model, each patient has a personal clinician working with a team of individuals to make sure the needs of the patient are met. The team is transdisciplinary because solutions to complex health issues require practitioners from an array of disciplines (medicine, nursing, social work, dentistry, psychology, and others) working together.”