Rising Burden on PCPs Lead to Declining Interest in Primary Care
For a patient, primary care physicians (PCPs) are the first point of contact in a healthcare system. They provide preventive care, teach healthy lifestyle choices, identify and treat common medical conditions and make referrals to medical specialists, when needed. A primary care physician is important for people to navigate to good health, stay healthy, prevent disease by identifying risk factors, and manage chronic disease for longevity and better quality of life. Medical transcription services help primary care physicians to prepare error-free EHR documentation.
Primary care physicians serve on the frontlines of healthcare. Primary care includes family medicine, internal medicine, nursing, pharmacy, pediatrics, general OB/GYN, gerontology, behavioral health, community health, optometrists, and the other people and professions who fulfil the general medical needs of patients. PCPs bring the most value to the healthcare system but unfortunately, they are the most to face burnout.
According to a recent article by Victoria Knight of Kaiser Health News, medical school graduates display a declining interest in primary care. Out of 8,116 primary care post graduate training positions, only 42 percent were filled by graduates of U.S. medical schools and the rest by Osteopathic graduates (DOs) and foreign medical school graduates (FMGs).
The American Association of Medical Colleges (AAMC) says that there will be a shortage of 21,100 to 55,200 PCPs by 2032. As per Knight, there are some reasons for the declining interest in primary care:
- Specialists earn more than PCPs
- PCPs must spend unjustifiable amount of time completing the electronic health record (EHR) and other insurer required paperwork
- Many medical schools overtly or covertly encourage graduates to pursue specialties
- 76 percent of medical students graduate with debt. According to the AAMC, the median debt in 2018 was $200,000.
Another important reason for this declining trend in primary care is that medical students realize that they will not be able to practice comprehensive medicine as they are trained and wish to do. They know that diseases that are complicated and need time for recovery need to be shifted to specialists, substantially increasing the total healthcare cost. They also feel that they do not get enough time to develop a trustworthy relationship with their patients.
Underrated value of primary care
Most people including medical students and physicians believe that primary care physicians treat only simple stuff. On the other hand, well-trained and experienced PCPs can handle most of the complex chronic illnesses that the American population currently faces such as diabetes, heart failure, obesity, hypertension and so on. These are the most common diseases that constitute 75-85 percent of all healthcare dollars. They are also skilled in addressing most of the mental health problems, including anxiety, which drives a large percentage of medical visits. Moreover, PCPs also know when it is appropriate to refer a patient for more specialized care.
PCPs have to consult more number of patients per day to cover their costs and maintain their incomes. This is because insurers reimburse PCPs at low rates and do not recognize the value involved in taking history, thorough examinations and the time spent on learning and thinking. They are also burdened with many new requirements like ‘feeding’ the EHR and it compromises the time spent with the patients. For those patients whose PCP follow the 24 -30 patients per day model results in less comprehensive care, in adequate care coordination, more referrals to specialists, more ER visits and very less satisfaction.
Overcoming the crisis
There are various approaches to solve the crisis that the primary care department is facing. The first step is to minimize their practice size from the 2500- 3000 patients to 400 to 800 patients. The PCP/nurse practitioner can offer same-day or next-day appointments that are sufficiently long, and also provide prompt access via cell phone and email. Patients receive a complete annual evaluation alongside special attention to prevention and wellness.
- Direct primary care (DPC), an approach that is usually the least expensive but entails seeing more patients
- Retainer based
- Membership based
- Concierge medicine, an expensive approach but physicians have fewer patients in their practice.
In all of these models, PCPs usually charge patients an annual or a monthly fee that covers some or all services. DPC allows adequate time per patients, coordination of care when a specialist is needed, 24/7 access, and most importantly, the opportunity to develop real trust, better attention to chronic illness and improved quality of care. It also ensures greater patient satisfaction and less physician burnout.
To make documentation tasks easier, primary care physicians can also seek the assistance of a reliable medical transcription company. This service makes use of versatile, adaptable software that enables quick transcription of physician’s recordings, accurate and precise transcripts and timely entries in the electronic health record.