Primary Care improves health outcomes and reduces costs.
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Primary care is crucial for improving health outcomes and lowering overall healthcare costs. According to a 2021 report from the National Academies of Sciences, Engineering, and Medicine, “People in countries and health systems with high-quality primary care enjoy better health outcomes and more health equity.” Investing in primary care also reduces overall healthcare costs. As the Purchaser Business Group on Health (PBGH) reported in 2021:
Evidence shows that improved primary care translates into healthier, happier patients and lower overall health care costs:
- U.S. adults who regularly see a primary care physician have 33% lower health care costs and 19% lower odds of dying prematurely than those who see only a specialist.
- The U.S. could save $67 billion each year if everyone used a primary care provider as their principal source of care.
- Every $1 increase in primary care spending produces $13 in savings.
The problem, however, is that there is a growing shortage of Primary Care Physicians (PCPs). The Covid pandemic only accelerated a disturbing trend: more and more PCPs are burned out from the need to see large numbers of patients and growing administrative burdens; and they are either retiring or transitioning to “concierge” practices, which reduces the size of their patient panels.
In addition, fewer medical students are going into primary care because other specialties are more lucrative at a time when medical school debt is mounting.
The result of the combination of these factors, according to the Association of American Medical Colleges (AAMC), is that the U.S. is expected to face a shortage of 21,000 to 55,000 PCPs by 2033.
Strategies for Addressing the PCP Shortage
A strategy we implemented at FastMed in North Carolina when I was the company’s CEO is offering primary care as well as urgent care in some clinics. The logic behind our decision to do this began a few years ago when we surveyed many of our urgent care patients and found that a substantial portion did not have a primary care provider.
When we then asked these patients whether they would use primary care services if we offered them at our urgent care clinics, a substantial percentage of them said they would. This was not surprising because my long experience with retail-based and urgent care clinics has consistently shown that convenience is a significant driver in consumers’ ability and desire to access basic healthcare services.
Advanced Practice Providers to the Rescue
While offering family medicine at the same conveniently-located clinics where urgent care and occupational health services are offered improves access, it does not directly address the primary care physician shortage. In order to do this, the primary care services offered in FastMed clinics – which we referred to as “family medicine” to distinguish it from the treatment of patients with serious comorbidities that need more specialized attention than we were set up to provide – were mostly provided by Advanced Practice Providers (APPs) rather than physicians.
APPs are masters-prepared nurse practitioners and physician assistants who enter into collaborative practice agreements with local physicians who delegate their prescriptive authority to our APPs and are available to them for consultations, but who do not have to be on site at the points of care.
Research has consistently shown that APPs are able to provide care that is comparable in quality to that of physicians within the limited scope of many primary care practices, and it is essential to patients and to our healthcare system as a whole that APPs (and all other healthcare workers) be allowed to practice at the top of their medical licenses.
Virtual Care Plays a Key Role
The third component of our strategy to increase access to primary care services was to provide care virtually when it was appropriate. The basic concept was that we would treat patients virtually if we could, and if not, we would refer them to a nearby clinic. Obviously not all medical conditions can be treated virtually, although the number that can be is expanding all the time and virtual visits can be particularly effective in follow-up care.
In general, offering virtual care expands access – particularly in underserved areas – provides convenience to patients, reduces costs, and increases clinician productivity if they are able to see patients virtually when they are not seeing them in person.
Increasing Access and Health Equity
Increasing access to primary care in the face of a growing primary care physician shortage is a significant challenge, but it is crucial in improving health outcomes and equity, and in reducing costs. At FastMed, we were by no means declaring victory in meeting this challenge, but we and other retail medicine providers were able to begin making a dent in it by offering family medicine in some of our urgent care clinics, using APPs rather than physicians to provide the care, and treating patients virtually whenever possible.
Stay tuned for my next blog, which will discuss the role of what’s called “value-based care” in supporting primary care practices and aligning incentives so that the care being provided is driven by patients’ outcomes rather than the number of patient visits, tests, and procedures.