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Primary care docs play a vital role
With the soaring complexity and expense of medicine these days, experts say that patients should make sure they have a primary care doctor, such as a family physician or internist. This caregiver – often now part of a team, perhaps with physician assistants or nurse practitioners – can deal with many of patients’ lesser and routine medical needs. They can treat common respiratory infections and allergies, as well as patching up cuts and other injuries. They can ensure patients get their needed vaccinations and checkups. Regular care with them could be a key way to keep patients out of the ordeal of getting what can be one of the most expensive kind of care — treatment in an emergency department. Primary doctors can be vital monitors over time about your health and well-being, getting to know you and your loved ones in a deepening and important fashion. As one published study found about the role of primary care doctors: “[Researchers] found that adults with primary care were significantly more likely to fill more prescriptions and to have a routine preventive visit in the past year. They were also significantly more likely to receive more high-value care such as cancer screenings, including colorectal cancer screening and mammography.” Primary care doctors can be valuable “quarterbacks” in coordinating care, recommending specialists when needed and helping to oversee how multiple clinicians treat patients with difficult, complicated, and chronic conditions. Patients may turn to specialists (like cardiologists or oncologists) for their primary care needs. This can work, particularly if treatment for a chronic condition falls primarily in a specialty area. It also may be a bit of medical overkill, with highly credentialed caregivers dealing with issues that others with less education or training could handle as well — and likely at lower cost and perhaps with greater scheduling convenience. By the way, the rise of stand-alone treatment facilities — urgent care and surgical centers, some under the roofs of familiar retail drug stores — can be helpful and convenient. But patients should remember that these facilities typically do not provide the sustained, long-term medical care that allows doctors to see important trends in individuals’ health and well-being. |
Patients feeling pinch of rising MD shortfall |
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This country faces a significant shortfall of doctors – and patients are starting to feel the crunch. There are longer waits for appointments, and in swaths of the nation medical care is getting downright hard to find. In the next dozen or so years, according to medical educators, the physician shortage will amount to almost 90,000 clinicians. That is less than some glum forecasts calculated, but this is a looming public health problem that will not be easily resolved. It takes a long time and a pile of money and other resources to train doctors. That leaves aspirants with not only demanding years of toil but also debts that stack up to hundreds of thousands of dollars. While there is great need for primary care physicians (see the other sidebar), young doctors may find that their debt and desire for a more comfortable life leads them to more lucrative specialties. Many doctors prefer to live and practice in cities, rather than in exurban or rural areas where they may struggle with lower compensation, higher caseloads, and fewer and less than state-of-the-art facilities. The coronavirus pandemic, with its shocking surge in abusive and even violent conduct against doctors and nurses (still persisting, by the way), has only worsened the looming shortages of health care personnel, experts say. To further complicate the growing MD shortage, significant numbers of clinicians are boomers – a giant generation whose retirements are reshaping U.S. society. Experts have proposed an array of steps the country could take to increase the doctor supply without undermining the quality and safety of U.S. medical care. These include greater investment in medical education, notably in easing the financial burdens of students and increasing the opportunities for them in medical schools, internships, and residencies. Reformers want big reductions in the blizzard of medical paperwork, increases in the employment of useful technologies (including telehealth?). They hope for major changes in doctor compensation, especially so primary care is more rewarding and all MDs battle less with federal reimbursement programs like Medicare and Medicaid. Doctors, critics say, also must pull in the sharp elbows they throw as advocates try to improve the scope of others’ “practicing up to one’s credentials.” This is a mindset that better recognizes that PAs and highly trained nurses could handle more routine medical care, freeing doctors to focus on diagnoses and treatments that require their deep education, training, and experience. Doctors themselves would, in this approach, also better coordinate their care, with primary physicians helping to shepherd patients through a thicket of specialists. Patients, in a new era, also would be pushed to think about medical care and their doctors and treatment in a different way. The focus would be on healthier living and prevention of disease, notably chronic conditions like obesity, diabetes, heart disease, and cancer that crush so many people now. |
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