Primary care: it's bigger than primary care medicine

Friday, I spoke to the board of the American Academy of Family Physicians (AAFP) about pending fiscal cliffs discussions and the implementation of the Affordable Care Act (ACA). Its board members hail from places like Wasilla, Alaska and Kingsport, Tennessee; one in three is employed by a hospital.

Primary care providers are my heroes. They do the work that is less sexy and less lucrative than specialists’ work, and earn half to a third of what they’d make had they chosen a different medical career path.

I share the group’s surmise that demand for primary care health services will grow as Medicare enrollment swells and up to 32 million get coverage through the ACA. And, I share their belief that primary care medicine is under-compensated, under-appreciated, and under-resourced. Where I part their company is in how the future looks―especially when I look at solutions.

Yes, demand for primary care is increasing, but primary care services delivered by MDs and DOs is only part of the solution. Clinical, dental, vision, nutritional, pharmacology, and psychological care are key elements, and strategically, much of what’s “necessary primary care” are deliverables that nurse practitioners and allied health professionals can provide safely and effectively. The data strongly suggest consumers define primary care more broadly and value it more favorably if comprehensive, coordinated, and inclusive of these features. And, technologies that equip consumers to engage directly in their health care have been effective in reducing unnecessary visits to doctor’s offices—the basis for the claim that they’ll be slammed if the profession’s complaints are not addressed.

So perhaps AAFP and its kin in primary care medical specialties should embrace a broader definition of primary care, and set aside the bromide that the primary care shortage can only be solved by growing physician supply and increasing compensation. Primary care is the foundation for the new normal, but it’s a very different model than many in the medical profession support.

The answer is not primary care medicine; it’s primary care delivered through a team of health professionals who leverage technologies and shared risk with consumers to equip them to care better for themselves. But to get from here to there, great folks like the AAFP board have to embrace reality: primary care is bigger than primary care medicine.

by Paul H. Keckley, PhD, Executive Director

Deloitte Center for Health Solutions

Comments

[LSpark]

It's nice in theory, but in order to really make a meaningful change in this area, the payment model needs to be altered.