The End of Primary Care As We Know It - Part II

What Do Primary Care Physicians Do and What is it Worth?

According to one of several definitions by the American Academy of Family Physicians, "Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the "undifferentiated" patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis".Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.

For many years, comparative compensation surveys have shown the work of primary care physicians to be valued less than that of specialists. So why is primary care considered of lesser value than services by specialists? One possible reason is that specialists deal with "differentiated patients", i.e. those who have defined problems that require a high skill level to treat. Only sick people seek the services of specialists while a vast majority of patients seeking services from a primary care physician are not seriously ill or have only minor illnesses that can be readily diagnosed and treated. Third party payers do not pay a high fee for treating minor problems or no real medical problem at all. Advocates argue that the services of primary care physicians is undervalued stating that primary care physicians can resolve minor problems before they become major problems, and they may be able to influence patients to behave in a manner that promotes wellness. Obviously, neither of these arguments has influenced society to place a high economic value on primary care physicians’ services.

In fact nurse practitioners may be equally capable of providing a similar form of care. And regarding wellness promotion primary care physicians can only have limited influence on patients compared with other forces in the environment, especially given that relatively healthy patient may visit a primary care physician one or two times a year, and patients under thirty even less frequently.

This begs the question "Are Educated and Trained Medical Doctors Needed as Primary Care Providers?" This will be addressed in the next blog post.