Report says primary health care at risk

A dire warning was sounded in January about the state of the nation’s health care: Without major changes to delivery and funding of primary-care medicine, this frontline of health care will collapse.

In “The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care,” the American College of Physicians (ACP), a professional group of more than 119,000 medical doctors and students, reports that primary care is suffering. And this will mean decreased levels of care at higher costs for Americans.

Primary-care physicians, also called internists or general medicine practitioners, are the doctors that patients see most often and who coordinate patients’ overall medical care, including making referrals to specialists and managing treatment of chronic disease.

“Immediate and comprehensive reforms are required to replace systems that undermine and undervalue the relationship between patients and their personal physicians. If these reforms do not take place, within a few years there will not be enough primary care physicians to take care of an aging population with increasing incidences of chronic diseases,” the report states.

Among the biggest problems facing the nation’s health-care system, according to the report:

- The demand for health-care services will balloon over the next 10-20 years, as the baby boomer population ages. By 2030, one-fifth of Americans will be above age 65 with an increasing percentage above age 85.

- Fewer physicians are going into primary care, opting instead to go into more lucrative specialty practices. In 2003 only 27 percent of third-year medical students planned to practice general medicine compared to 54 percent in 1998. Meanwhile, 35 percent of the nation’s physicians are over age 55, and will be retiring in the next five to 10 years.

- Medicare has established payment rates that “under-value office visits and other evaluation and management services provided principally by primary-care physicians,” according to the report. Yet these services, such as phone or e-mail consultations, can improve the delivery of health care by reducing the need for office visits and by heading off expensive interventions later on, the report states.

- Specialization has replaced primary care at times where it is unnecessary and not cost effective. For example, primary-care physicians can deliver the same quality of care as specialists for diabetes and hypertension, but using fewer resources and at lower cost, the report states.

“Unless immediate and comprehensive reforms are implemented … primary care, the backbone of the U.S. health care system, will collapse. The consequences will be higher costs and lower quality as patients find themselves in a confusing, fragmented and over-specialized system in which on one physician accepts responsibility for their care, and no one physician is accountable to them for the quality of care provided,” the report concludes.

For more information about the ACP’s report and its recommendations see www.acponline.org/hpp/statehc06.htm