Primary care access vital

March 16, 2009
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As we transform health care in the United States, we have to be careful to address the availability of primary care.  If we focus future policy on cutting costs and reducing payment levels for all services, we will miss the opportunity to improve the quality and access to care.  We need to get everyone a primary care physician.

Many people think that seeing a specialist for every problem is the best approach to medical care. Studies would prove them wrong. Primary care physicians, or PCPs, (family practice physicians, internists, pediatricians) — especially one you have learned to trust — would do fewer tests and get better long-term results.

Why should this be? Specialists are trained to think of the worst possible diagnosis and do tests to rule it out. Also, an emergency room visit cannot do effective preventive care. Primary care physicians are concerned about the whole person and encourage behaviors that have been proven to prolong life, such as controlling blood pressure, maintaining healthy weight, quitting smoking, keeping cholesterol levels normal and getting recommended vaccines. A recent study showed that people with a primary care physician had a 19 percent lower mortality rate and spent 33 percent less annually on health care.

When something goes wrong, PCPs are in the best position to coordinate care among specialists. This happens by a team of doctors all talking among themselves about the patient, with the end result being the most appropriate course of action. To use a sports analogy, your team can have the best receivers and linemen in your football league, but without a good quarterback, it will not do well. This is NOT a gatekeeper model; rather it is a model that makes sure a person gets preventive measures early and the appropriate medical services when they are sick or injured.

PCPs handle hundreds of conditions and are in a much better position to pick up the onset of depression, memory loss, change of gait or a bad hip. They gain a person’s trust over years and can tell if something is serious or just needs to be watched. 

The patient-centered medical home (PC-MH) concept is endorsed by all the primary care specialty societies. This is a focus on quality of care over the lifetime of the person. It relies on one physician having all the data generated at different facilities and using it to provide the best possible care at the right time. The four main features of a PC-MH: first contact access, long-term person-focused (not disease) care, comprehensive care for most health needs, and coordinated care when it includes specialists. 

It is a sad fact that PCPs are not reimbursed according to the necessity and importance of their work. This has resulted in an imbalance in the percentage of PCPs, currently 30 percent in the United States, compared to 50 percent in Europe and most other advanced countries. Medical students have little incentive to go into primary care when their debts after medical school exceed what they could pay back as PCPs. Studies in the U.S. showed that those states with higher ratios of primary care doctors to population had better health outcomes, with lower all-cause mortality. As we change health care policy, we need to improve reimbursement to PCPs and create information and health care delivery systems that support the patient-centered medical home as the foundation of medical care.

As a specialist physician, I do not worry about my own health care decisions; I ask my PCP what I should do and follow his advice.

Grand Rapids gastroenterologist Dr. Paul Farr is past president of the Michigan State Medical Society. He has been a specialist with Grand River Gastroenterology PC.

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