Primary care in the United States is a paltry shadow of what it used to be and nothing like what it is in other developed countries in the world. I can point to numerous articles that confirm this slow death since the 1990’s:
I can also point to numerous articles that validate that a vibrant and strong primary care component in a health system improves outcomes and lowers costs for a population:
This slow death of primary care has many origins, starting with the disparate incomes of primary care physicians versus specialists. It’s a negative spiral that only serves to degrade and decrease the number of new physicians into the primary care fields. In fact, only 5% of graduating medical residents in the United States chose primary care as a profession over the past decade or so.
This graph tells it all (source):
Adding dirt to the wound, there is currently a ‘silent exodus’ of primary care physicians as we speak. I know of other primary care colleagues who have packed up their outpatient practice and headed for the hills of hospitalist medicine, urgent care, or non-clinical jobs (one popular one is a company that serves hospitals to make sure that they meet compliance with Medicare readmission guidelines, it’s something that you can do from home).
If you think about it, these other avenues I mentioned are really picking up the void that is left behind when primary care had been decimated. Economically, these avenues are much more attractive to the hapless primary care physician, and it’s doing the work that had primary care really done it’s job in prevention, we wouldn’t have to get to the point of acute, higher-cost care. It’s another negative spiral.
This whole thing stinks of negative vortexes and the cost of health care conundrum is just a big black hole sucking up everything in its path. It is a very sad state of affairs for primary care physicians.
I was a victim too – I closed my practice down in 2012 due to the increasing uncompensated demands by insurance and continued decline of reimbursement for my services. My NOSH ChartingSystem worked wonders for my productivity but it didn’t matter because the greater problem was something that my EHR alone could not solve. As I had mentioned before on my blog regarding EHR certification, certain laws have made it much, much harder for a primary care physician to survive. Whether it was intended or not, these policy decisions have continued to push the extinction of primary care physicians like me, especially those who are trying to pave a brave, new path against the current trend of seeing more patients in less time.
So now, we’re at a crossroads. Can primary care be reinvigorated? Is it too late to change?
I think primary care can be reinvigorated. In time, we as a society will look upon this time of decline as something that we should never repeat again. I fear, though, that the kind of change and the kind of vibrancy that primary care can be will not be fully realized in my lifetime (with tears in my eyes). But with this project, maybe I can bring about the solidarity and voice that is needed to bring primary care out of the ashes towards a better future.