Saturday, October 31, 2009

Learning About Primary Care Shortages

The United States currently faces a shortage of primary care professionals that threatens to develop into a major crisis if not addressed. Primary care comprises four main features:

  • A first contact for any new health issue or need
  • Long-term, person-focused care
  • Comprehensive care for most health needs
  • Coordination of care when it must be received elsewhere (i.e. with a specialist)

General practitioners, general internal medicine practitioners, family physicians, and sometimes general pediatricians are considered primary care physicians. Other health care providers, such as physician assistants (PAs), nurse practitioners (NPs), nurses, and health coaches or care coordinators, may also provide primary care. Care delivered with an orientation toward primary care has been found to be associated with more effective, equitable, and efficient health services; residents of countries more oriented to primary care report better health at lower costs.

60 million Americans, or nearly one in five, lack adequate access to primary care due to a shortage of primary care physicians in their communities. Very few new physicians today are choosing to enter primary care: whereas fifty years ago, half of U.S. doctors practiced primary care, just over 30% do today, and just 8% of the nation’s medical school graduates enter family medicine compared to 14% as recently as 2000. People who are uninsured, low-income, members of racial and ethnic minority groups, or living in rural or inner-city areas are disproportionately likely to lack a usual source of care (USC)—a key indicator of access to a primary care provider.

Many experts believe that this skewed distribution contributes to overspecialization of care and fragmentation and inefficiency in the health system; for example, more than half of specialist visits are for routine follow-up, a misuse of expensive care. Furthermore, a higher ratio of primary care physicians to population is associated with lower mortality rates while a higher ratio of specialists to population has been correlated with higher mortality rates, perhaps because patients with a usual source of primary care tend to use more preventive health care and have health problems treated at a less advanced stage.

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