The future of primary care can look downright frightening.
Georgia and the rest of the nation already have a general shortage of obstetricians, internists, pediatricians and family medicine doctors, especially in rural and urban areas. And things are getting worse. The Health Resources and Services Administration forecasts a shortage of 65,000 primary care physicians in the U.S. in 2020.
Meanwhile, most physicians coming out of medical school are gravitating toward specialty medicine instead of front-line care.
If the Affordable Care Act is upheld by the Supreme Court, the law will enable 30 million uninsured Americans to gain coverage. A common prediction is that many of those newly insured people will immediately seek the physician services they have long needed, swamping primary care practices.
Currently, on the other hand, many uninsured patients put off seeking care until ‘‘the pain is unbearable,’’ said Dr. David Satcher, director of the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta.
Satcher, a former U.S. surgeon general and CDC director, joined a panel that addressed the future of primary care last week in Atlanta at the Association of Health Care Journalists conference.
The experts’ presentations suggested there may be no single answer to the nation’s primary care problem, but rather a number of partial remedies that, taken together, may fill in some of these vexing gaps in our health care system.
Currently, we’re not getting enough bang for our bucks. The United States spends more money on health than any other country, but dozens of other nations have better medical outcomes and statistics, such as life expectancy.
Georgia has a major numbers problem with primary care. The state’s population is increasing faster than its supply of primary care doctors, says the Georgia Board for Physician Workforce.
Twenty-five of Georgia’s 159 counties lack a pediatrician, and 34 counties have no obstetrician, according to recent statistics.
Satcher pointed out Friday that primary care has been devalued, as med students are choosing subspecialty areas because of the better pay and prestige. Yet the Affordable Care Act puts more emphasis on primary care, he said.
Among other items, the 2010 law boosts money for training new providers, creates pay incentives, increases funding for community health centers, and will raise Medicaid reimbursements for physicians.
The law also provides for an expansion of the National Health Service Corps, which pay off educational loans and provides scholarships for primary care providers who practice in areas where there are shortages. About 50 percent of these doctors remain to practice long term in these communities, Satcher said.
Meanwhile, some medical practices, including community health centers, are integrating mental health and physical health, a trend that Satcher sees as valuable for reducing the social stigma attached to mental illness. “The brain is part of the body,’’ he noted.
The nation must train more minority physicians, Satcher added.
The ‘home’ concept
Dr. Frank Don Diego of Rome said the patient-centered concept known as a “medical home’’ has the potential to revamp primary care -– and attract more providers.
Don Diego, a family physician, has established a medical home in his northwest Georgia city. It’s a team approach to health care, where intake people do more than just check patients in, but also call them to remind them of regular appointments.
Under this concept, a primary care doctor coordinates care for all the patient’s needs. This would include managing chronic diseases such as asthma and diabetes and delivering other services that aren’t now reimbursed.
It may mean having 24-hour access for patients as an alternative to the emergency room, or bringing in a social worker or psychologist to work with a patient.
Major insurers have decided to pay more for care delivered in a medical home model. An HMO may pay the salary of a care coordinator in a medical home practice, Don Diego said, with a potential to lower ER visits and hospitalizations. “This is dollars,’’ Don Diego said.
The medical home idea is being pushed by medical provider groups as a way to reshape the state’s Medicaid delivery system.
A third member of the panel, Dr. Barbara Schuster, campus dean of the Georgia Health Sciences University/UGA Medical Partnership, noted that primary care has evolved away from the standard definition of a doctor delivering all needed care in a continuous fashion.
Primary care is now being provided by different professions, from pharmacists giving health information to nurse practitioners at retail clinics treating sore throats, Schuster noted. She pointed out that some doctors demand $50 for an office visit – and won’t take insurance. Others, meanwhile, have started concierge practices, under which individual patients can pay more than $1,000 a year for personalized service.
One idea that worked, Schuster noted, came in Rochester, N.Y., where pediatricians were paid more to work weekend hours, a tactic that can lower ER visits for children and therefore reduce health costs.
Advanced practice nurses can provide 80 percent of primary care, Schuster said.
Satcher agreed that nurses and physician assistants can play an important role in the primary care equation. “Primary care is a team sport,’’ he said.
The panelists also see a promising trend on the horizon: The increasing use of electronic medical records should eliminate much of the waste and duplication that now hinder the health care system.