Primary care is vital to increasing access. In the United States there are an estimated 45 million individuals who are uninsured. Eighty percent of those individuals are employed or live with an employed adult. 18 million of these individuals have a family income over $50,000 per year (Kaiser, 2010). Because 75 – 85% of the United States population seeks primary care in a year, attention to this aspect of health care is crucial (Shi & Singh, 2008).
Primary care is central to decreasing cost. Because primary care appointments cost less on average, we can receive more with less money. For example, the average bill from a family practitioner is $62, a bill from a specialist can be upwards of $90 (AAFP, 2010; Figure 1). Primary care costs less because these physicians orders less tests and receives the same or better results than specialists. This decrease in tests is also correlated with a decreased iatrogenic complication (Shi & Singh, 2008). While an estimated 50% of emergency department visits would be better handled in the primary care setting, patients who lack insurance continue to overrun emergency departments to get their necessary care (Shi & Singh, 2008).
Primary care certainly betters the quality of care. This has been shown with epidemiological data. We see areas with a higher ratio of primary care physician yield better health results. Several studies have shown that an increase in primary care providers in a given region have yielded a decrease in cancer, heart disease, stroke and infant mortality, in addition to a decrease in low birth rate, and an increase in life expectancy. Furthermore, an increase of just one primary care provider per 10,000 individuals has shown to decrease mortality by 5.3% (County Health Rankings, 2010). In the U.S., about 43% or practicing physicians work in the primary care setting as opposed to 50% and 70 – 72% in Canada and Great Britain, respectively (Shi & Singh, 2008; Figure 2). Both of these countries are ranked higher than the U.S. on the World Health Organizations list (World Health Organization, 2010).
As the foundation of our country’s health care system, primary care is currently relatively weak. Over the previous eight years, we have seen a 20% increase in specialization by internal medicine residents resulting in less primary care providers and yet more specialists. Additionally we have seen 15% fewer residency spots filled in the U.S., while half of these positions are being filled by foreign graduates (Riselbach, et al).
Given the preceding information, it should be quite clear that consideration of primary care is essential to the success of health care reform. While this may be one of the most important pieces, we concede that without a system for providers to work in improvement will be negligible.
References
Shi, L., & Singh, D. A. (2008). Delivering health care in America: a systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc
Henry J. Kaiser Family Foundation. (2010) www.kff.org. Accessed 2/19/2010.
American Academy of Family Physicians (2010) www.afp.org. Accessed 2/19/2010.
County Health Rankings (2010) Access to Care. www.countyhealthrankings.org. Accessed 2/19/2010
World Health Organizations (2009). www.who.int. Accessed 2/19/2010.
Rieselbach, R.E., Crouse, B.J., Frohna, J.G. (2009) Teaching Primary Care in Community Health Centers: Addressing the Workforce Crisis for the Underserved. Annals of Internal Medicine.
This post did a great job of showing the importance of primary care. With only 43% of physicians in the U.S. going into primary care, the question becomes how do we get more medical students to choose primary care. What are realistic, viable ways to increase the number of primary care physicians in the United States?
ReplyDeleteThanks for the comment! These are great questions. It is of concern that only 43% of all U.S. medical students choose primary care. As a country we should have at least 50% of our physicians serving a primary care role. Some sources indicate the need to be upward of even 70%! This year "the match" indicated 9% more medical student chose family medicine this year over last. It has been shown that students who acquire less debt have a greater propensity to choose a primary care career. We believe that decreasing the cost of enrollment, increased benefits for primary care salaries, and an increase in primary care physicians serving in leadership roles throughout health care will increase the number of student choosing primary care.
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