Health Care Reform-Primary & Outpatient Care

As emphasized before, primary and outpatient care is extremely important, if not the most important aspect of healthcare. Primary care serves as the foundation for health care and any health care reform. As shown, an increase of just one primary care provider per 10,000 individuals has shown to decrease mortality by 5.3% (County Health Rankings, 2010). Primary care physicians are central to any health care reform. Currently, there is a 20% increase in specialization by internal medicine residents resulting in less primary care providers (Riselbach, et al). The following table shows the percentages of medical school graduates who contemplated careers in generalist specialties (Petersdorf & Goitein, 1999).

We feel primary care can be greatly improved if more emphasis is placed on the medical school environment. Our health care reform, then, addresses an underlying cause to the imbalance between primary and specialty care services, which has contributed to an imbalance in the ratio of generalists to specialists (Shi & Singh, 2008). Our reform proposes solutions to help influence the career choices of medical students and physicians already in residency programs (Monegain, 2009). We feel primary care physicians should have effective incentives and be eligible to receive additional funding and support (Monegain, 2009). We feel much can be done to make the medical school environment friendlier to primary care, thus improving all aspects of primary and outpatient care. We suggest the following proposals:
1. Medical schools should devote significant sections of the curriculum to general and ambulatory experiences.
2. Student should also be exposed to strong generalist role models and mentors. There should be an increased emphasis on teaching general internal medicine.
3. Generalists should also be offered prominent positions within academic medicine, as chairpersons, deans, and committee members.
4. Medical schools should strengthen their primary care departments by improving research and fellowship training programs.
5. Financial incentives such as loan forgiveness should be established to encourage medical students to choose generalist careers (AAFP, 2010; Annual Residency Completion Survey 2008).


6. There should be an increase in the number of primary care tracks.
7. Most importantly we feel the size of subspecialty programs should be downsized. This can be done by limiting the number of applicants into specialty fields (Petersdorf & Goitein, 1999).


(AAFP, 2010; Michael Munger, M.D., examines a patient at his medical office in Overland Park, Kan.)

We feel the medical school environment can act to reduce the disparities among primary care and specialty care physicians by implementing our seven proposals. Many factors will be changed, primarily the medical education programs themselves. However, we do feel these changes will be cost effective for patients considering the median expenses per office-based physician visit (AAFP, 2010; Figure 1). These seven suggestions also improve access for the estimated 45 million individuals who are uninsured bringing health care closer to where people live and work (Shi & Singh, 2008). Not only does our reform improve cost and access, it will also enhance quality as primary care focuses on the person as a whole, whereas specialty care centers on particular diseases or organ systems of the body (Shi & Singh, 2008).

References

1. American Academy of Family Physicians (2010) www.afp.org. Accessed 2/26/2010.
2. County Health Rankings (2010) Access to Care. www.countyhealthrankings.org. Accessed 2/26/2010.
3. Monegain, B. (2009, February 4). Docs say primary care physicians central to healthcare reform. Retrieved from http://www.healthcarefinancenews.com/news/docs-say-primary-care-physicians-central-healthcare-reform.
4. Petersdorf, R.G., & Goitein, Lara. (1999). The Future of internal medicine. Annals of Internal Medicine, 119(11), 1130-1137.
5. 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.
6. Shi, L., & Singh, D. A. (2008). Delivering health care in America: a systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.