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Part One – The Problem with the Status Quo   

   

From the New York Times to KevinMD.com blog, every news publication you pick up (or click on) seems to have at least one headline concerning primary care and with terms like “uncompensated pressures,” “collapsing system” and “crisis point” thrown around, it ain’t lookin’ good.  The May edition of Health Affairs entirely dedicated to primary care issued warnings with only glimpses of optimism…but at least we’ve been warned.   

One of an ever-growing list of problems with primary care is a lack of time, or at least an inefficient and inadequately compensated use of physicians’ time.  In 2008, an internist’s practice, highlighted recently in the New England Journal of Medicine, took 23.7 calls per physician per day, with nearly 80 percent of such calls handled directly by physicians, on top of receiving 16.8 e-mails per day.   

As Lawrence Casalino, MD describes in a Health Affairs article, more and more of physicians’ time is devoted to patient education on chronic conditions like diabetes, heart disease, cancer and asthma, which directly contribute to the nation’s astronomically high health care costs.  Consultations not only with patients but also with specialists take up an increasingly amount of this precious resource – but with what consequence?   

Quality of care suffers During longer visits, Casalino says, PCPs can “take the time to reflect, investigate, and learn when faced with puzzling problems, or when potentially critical diagnostic and therapeutic decisions had to be made. They would engage in many telephone and e-mail communications with patients, specialist physicians, and other health care workers, such as home health nurses.”  Patients’ whole-person and long-term health needs often take a backseat to quick decisions, pressured by a waiting room full of other patients.   

Access issues become exacerbated How many times have you been in a waiting room an hour after your appointment time?  With 40 million individuals gaining coverage under federal health reform, conditions are expected to only worsen without change.   

Physicians’ burn out and experience job dissatisfaction According to an Annals of Internal Medicine article, almost half of primary care physicians report moderately or highly stressful jobs, more than a quarter report burnout, and nearly a third were at least moderately likely to leave their practices within two years.   

Not surprisingly, primary care does not appeal to students Given that less than 10 percent of med school graduates go into primary care, as the New York Times wrote, the current health care system is reaching a “crisis point.”   

Parts 2 and 3, to be posted separately over the next two weeks, will consider possible solutions states are exploring.

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