The Primary Problem with Primary Care - Fixing The Primary Care Crisis

You may think of primary care as going to the doctor with the flu, a sprained ankle, a urinary tract infection or some other minor problem. In fact, primary care much more. First and foremost, comprehensive primary care is about developing a close relationship between you and your doctor-relationship medicine is the essential ingredient for trust building and for true healing. It is also about treating more serious problems such as heart failure, asthma, high blood pressure and diabetes without the need for specialists in most cases. Effective primary care is about working to prevent these chronic diseases from occurring or to slow the progression of disease once it has occurred. It is also about maintaining wellness and health throughout life. In short, your PCP can handle about 95% of your healthcare needs and do it very effectively and cost efficiently. There is strong data I discuss in the book to support the notion that true comprehensive primary care not only increases quality of care but substantially decreases costs.

To be effective, a PCP needs time to listen, diagnose, treat, prevent and -most importantly-think. Price controls by insurers have effectively forced them to see many more patients per day which translates into shorter visits per patient. While short visits are fine for simple problems, they are not appropriate for an elderly patient who has multiple chronic illnesses, is taking 5-7 prescription medications and may be suffering from visual, hearing or memory problems. With short visit the result is an over-reliance on referrals to a specialist, resulting in often excessive testing and procedures when some more time by the PCP with the patient would have been all that was needed. Doctors are departing private practice in droves. Few medical students are choosing primary care as a career so the shortage is growing rapidly.

Primary care is a difficult, complex specialty to practice. It takes years of training and additional special skills. The current environment is discouraging students from choosing primary care as a career and accelerating the migration from private practice. A growing population of PCPs is critical to a successful healthcare system. Without a strong foundation of primary care physicians, our healthcare system will crumble, while costs-physical, emotional, and monetary-will continue to rise. This is the crisis and it is the most pressing health care issue today.



Copyright (c) Stephen C. Schimpff, MD