According to The New England Healthcare Institute, the primary care crisis is the "confluence of a rising demand for primary care and a decreasing supply of professionals providing these services.""
NEHI’s new report, "Remaking Primary Care: From Crisis to Opportunity," identifies the challenges facing primary care clinics and offers new approaches that could improve care quality and outcomes.
On the demand side, challenges to primary care are fueled by a demographic shift – the percentage of Americans aged 65 and older is expected to rise to more than 20 percent by 2050 – and an increase in chronic diseases. Currently, 87 percent of Americans aged 65-79 live with at least one chronic condition, and much of their care has shifted from hospitals to ambulatory care settings. This trend is expected to increase, and will continue to stress the primary care system’s resources.
On the supply side, NEHI said the low pay scale for primary care doctors and their dissatisfaction with high workloads, long hours and a sense of being undervalued are driving existing providers out of the profession while deterring new physicians from pursuing primary care. The proportion of primary care physicians has decreased from 50 percent of all physicians in 1950 to just over 30 percent in 2007, and a 2007 survey found only 5 percent of fourth-year medical students were interested in primary care. These declines are reflected among other primary care providers, including physician assistants and registered nurses.
According to the report, these trends are hindering patient access to care – 35 percent of family medicine practices in Massachusetts are closed to new patients – and reducing patient satisfaction with the quality of their care.
“The forces of supply and demand highlighted by NEHI threaten the quality of primary care, as physicians are pressured to see a ‘revolving door’ of patients,” said Wendy Everett, president of NEHI. “Patients are, in turn, not receiving the continuity of care required to prevent and manage chronic disease.”
NEHI is recommending innovations in service delivery, site of care, reimbursement and primary care education, including:
- Primary Care Team Training - Training physicians to lead teams of registered nurses, medical assistants and other professionals will help deliver more seamless, effective care.
- Patient-Centered Medical Home - Centralizing care at a single clinical setting will improve provider efficiency and satisfaction and increase patient access.
- New Sites of Care - Offering primary care services at retail clinics, worksites and in the home will increase the availability, accessibility and continuity of care for patients, particularly those with chronic illnesses.
- Health Information Technology (HIT) - Properly implemented, technology such as electronic medical records and computerized prescription ordering will free up physician time during visits, provide timely access to information and aid in the overall coordination of care.
- Improved Pay-for-Performance - Redesigning the system to pay for outcomes will move the system away from paying for episodic care.
“Educating primary care doctors in new ways and paying them for the quality, not the quantity, of care would help keep our patients healthier and leave our emergency departments less crowded,” said Joseph B. Martin, chairman emeritus of NEHI and Lefler Professor of Neurobiology at Harvard Medical School.