Notable and Quotable – Questions But No Answers about Primary Care

A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis.

Wikipedia

May 22, 2012 – I was talking to a family physician friend of mine. He remarked,”Where in the hell did the term primary care doctor’ come from?  I hate it.  It’s misleading.  For Christ Sake, we take care of most of the secondary problems, too. For a hell of a lot less money too. Where is the money coming from to support medical homes and the “team approach” to taking care of patients?   If you ask me, it’s all a pipe dream dreamed up by some academic.” I thought of him when I ran across the following in May 17 New England Journal of Medicine.

“The primary care doctor is a rapidly evolving species — and in the future could become an endangered one. As the United States grapples with the dual challenges of making health care more widely available and reducing the national price tag, it's hard to say how primary care physicians will fit into the delivery models that emerge. Will they be increasingly replaced by nurse practitioners and physician assistants? Will they become partners or leaders on multidisciplinary teams, spending more time supervising others and less interacting with patients? Will most become employees of large health systems, as solo and small-group practices disappear? Will having a primary care physician become a luxury, available chiefly to people who can pay a premium to enroll in a concierge practice?”

“Even the question of whether the country faces an impending doctor shortage is debatable: groups of experts have reached opposite conclusions depending on their assumptions about who will be delivering care in the future and how. The report of a conference held in May 2011, sponsored by the Josiah Macy Jr. Foundation, cited estimates predicting a shortage of more than 100,000 physicians by the middle of the next decade, with primary care specialties most affected.1 Meanwhile, another report, published last year by the Robert Wood Johnson Foundation, concluded, “Data do not support the suggestion that the United States is currently experiencing or facing an imminent shortage of primary care providers; numbers of physicians, nurse practitioners and physician assistants have grown in recent years relative to the general population.”2 That report, however, stated that such providers are profoundly maldistributed, resulting in severe shortages in rural areas and among underserved populations. It noted that nurse practitioners are the fastest-growing group of primary care practitioners, their numbers having grown by an average of more than 9% per year relative to the population in the 6 years ending in 2005.”

Source; Susan Okie, MD, “The Evolving Primary Care Physician.” New England Journal of Medicine,  May 17, 2012

Tweet:  The status of primary care practice is in flux, and where it goes from here, no one knows.