Finding a Practitioner for Primary Care

The shortage of primary care practitioners is here.  For example, 28 percent of people on Medicare who went looking fora primary care doc in 2008 had trouble finding one, according to the Medicare Payment Advisory Commission’s report to Congress.  (This figure has been over-interpreted in a major article, but no matter.)

photo of military physician assistant and colleague

The military has long used physician assistants, as here in Iraq

I want to share a few thoughts with you about what that means for the future of primary care and how we as patients can communicate effectively with practitioners, to get the care we want and need.  Many practitioners will not be physicians.

In February of last year, physician supply guru Richard A. Cooper told an Institute of Medicine conference that “the notion that future patients may experience regular 30-minute visits with a primary care physician is not credible.”  Why?  Not enough family physicians, general internists, general pediatricians, and obstetrician-gynecologists to spend a lot of time with reasonably healthy patients.

Similarly, USA Today noted in an August 16 article that 65 million Americans live in communities with a shortage of primary care physicians.  This shortage–as every health policy expert knows–results from low payment for primary care, or “talking,” and a lot higher payments for procedure-oriented specialties.  New graduates of medical schools choose the higher paying, more prestigious, less communicative fields.

Yet, ironically, merely increasing the numbers of primary care physicians in a community wouldn’t give more residents regular primary care visits, according to researchers.  The Dartmouth Atlas Project, which looks at variations in medical practice across geographic areas, emphasizes that what’s really important is for the primary care practitioner to take charge and coordinate the patient’s care with all of the patient’s specialists and providers.  (Joe Cantlupe reported this surprising finding in HealthLeaders Media on September 16.)

Taken together, these findings suggest that primary care of the future will involve more non-physicians.  More and more of us will see a nurse practitioner or physician assistant for routine visits.  The primary care physician will become engaged only when care gets complicated–such as when the patient has multiple chronic diseases or difficulty tolerating the usually prescribed drugs.

This could work fine.  Nurse practitioners have shown themselves able to handle most routine health problems very competently, and they spend time talking with patients.  Physician assistants, though slightly less highly educated, also have shown a great deal of competence and are relatively inexpensive to deploy.

My usual hesitation with using NPs and PAs as front-line primary care practitioners is that medical specialists are less likely to accept them as a colleague in conferring about the patient’s needs and treatment.  That problem disappears when the primary care physician, working in the same practice as the NP or PA, assumes the conferring role.

In short, we’ll see more primary care teams, composed of physicians, NPs, and PAs–and perhaps health educators,nutritionists, and others.

What are the implications of primary care teams for physician-patient communication, the theme of our blog?  Here are three:

  1. We’ll feel that we have more time to talk with primary care practitioners, and will feel less intimidated by them.
  2. We’ll have an excellent ally in efforts to communicate with specialists.
  3. We might get sloppy, becoming less prepared and focused when we visit the primary care practitioner, feeling that we don’t have to be so efficient when communicating with a non-physician.

Note that the first two results would be positive, and the last would be negative.

Take care.

Photo credit:  The National GuardAttribution.


One Response to Finding a Practitioner for Primary Care

  1. Karen Long says:

    This article underscores what is already a serious problem. I live in one of the largest metropolitan areas in the country with a plethora of medical practitioners and institutions. However, a friend, who is married to a physician, recently had difficulty finding a primary care practice taking new patients that was within a five mile radius of her home. Most practices were closed to new patients. I can imagine how much more difficult it is for patients on Medicare or Medicaid to locate a primary physician.

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