The short answer is better outcomes and lower costs.
Last week, I wrote about the role my GP plays in my personal medical circus. And it really is a circus. When I am giving a presentation, I always have notes because 99% of the time I will forget at least one or two conditions. Betcha my GP knows them all.
This week I want to talk about why GPs and family doctors (and nurse practitioners!) and primary care practices (ladies, this includes your regular Gyn care) are important in a larger sense.
If you listen to the people who are trying to improve the healthcare system through policy change, one thing that they discuss fairly frequently is the state of primary care practices in the United States. That’s because the more folks see primary care physicians (PCPs), the lower mortality rates tend to be. PCPs are the ones who see you regularly (annual is still regular), keep track of patient histories and family histories, monitor health indicators, most commonly provide preventive services, and they are the ones with whom people first build that vital trust relationship. They’re the ones who catch changes that could indicate illness.
Yes, sometimes it takes a while to find the right one – maybe it’s hard to connect with someone you see so infrequently or you don’t think it’s important enough to search until you find the right one who works for you. But it is worth it. With the population of chronic patients already huge and growing, primary care clinicians are often the ones who will diagnose patients and may provide the first waves of both treatment and information about a chronic condition. Diagnosis is such a sensitive, foundational period for chronic patients, not having a PCP, or not having one you trust, can set a bad precedent for the entire course of a patient’s condition.
Starting off on the right foot can help keep costs reasonable for chronic patients, but having access to a primary care clinician can also lower costs in other ways. Patients have someone to call when they do get sick, and who wouldn’t want to call someone you know instead of going to an emergency room? More generally, when something just feels off – say, shortness of breath that is annoying but doesn’t keep you from your life, just makes things harder or back pain that could be anything from sleeping wrong or an early sign of an aggressive cancer—a patient is more likely to bring it up if they know there is someone there who is supposed to listen to those kinds of things.
Though the value of primary care is indisputable, the number people who see one has been falling for a while, especially in younger adults. You know, the people who still think they’re invincible. Right now, of all that ridiculous number of dollars Americans spend on healthcare every year, we only spend somewhere around 6-7.5% on primary care. Additionally, primary care clinicians are reimbursed at lower rates than specialists, so many good candidates choose to become specialists, and while the number of primary care providers grew between 2005 and 2015, the percentage of primary care clinicians actually fell by 7%. Many of the ones who have recently chosen to be primary care clinicians have said that, given a chance to choose differently, they would go into another field of healthcare.
So, as patients, what can we do? Sadly, not a whole lot. One thing would be to find a primary care clinician if you don’t already have one. And if you don’t have the right one for you, find that person. Perhaps creating higher demand will spur the payers to change their formulas and find ways to incentivize primary care as an area of practice. The other way is to keep an eye on the places that are watching what happens with primary care, and to speak up if and when there is an opportunity. While this might include state or federal policy, information and innovation on primary care are much more likely to be found in executive agencies like Health and Human Services or the Centers for Medicare and Medicaid Services or state departments of health. There are also non-profits and interest groups like the Primary Care Collaborative and the Society to Improve Diagnostics in Medicine. These places will sometimes look for patient input when they are formulating research efforts and policy recommendations. As the ones affected most, we should let them know why all patients need ringleaders.