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    Here is the PCP crisis solution and it's simple

    As Congress and the new president consider the next steps with healthcare reform, they would do well to begin their deliberations around primary care.

    There is a primary care crisis in the United States. We know it because patients only get 8-12 minutes with their primary care physician (PCP) who interrupts them within about 18 seconds and never fully listens to them. Patients are sent for tests, given a prescription or referred to the specialist even though the PCP could—with more time—have figured out the problem without a test, prescription or referral.


    Hot topic: Top 10 challenges facing physicians in 2017


    Patients are less than satisfied, yet the charge is high. Doctors are no more satisfied and are highly frustrated, feeling like he or she is on a never-ending treadmill. This leads older PCPs to seek early retirement, mid-career PCPs to sell out to the local hospital and medical students to shun primary care—each leading to a growing shortage of PCPs, which will get worse as the population grows and ages.

    This means that Americans don’t get the quality of healthcare that they need and deserve, that healthcare is expensive and that the cost will keep rising.

    The solution isn’t difficult. The reimbursement system needs to change, shifting more resources into primary care and out of specialty care. It’s an easy answer but difficult to implement.

    It is important to note that primary care is not just for the “simple stuff.” PCPs are trained and experienced to care for complex chronic illnesses like diabetes and heart failure. They need to refer to specialists only occasionally. But PCPs have too little time per patient, so the reflex is to refer, test and prescribe, thus driving up health care costs. There is little time to address wellness, health and lifestyle changes and no time to develop and maintain a trusting relationship.

    Where does the time go? The typical PCP takes 24 phone calls per day, reads 17 emails, processes 12 prescription refills (above those handled during visits) and reviews more than 40 laboratory,  X-ray and specialist consult reports. In addition, PCPs need substantial added time with electronic health records and to complete Medicare quality indicators records.

    But the major time problem is that primary care providers are caught in a terrible conundrum. Overhead costs (especially the need for added staff to deal with billing, preauthorizations and government mandates) have risen much more quickly than revenue. The only remedy is to “make it up with volume,” i.e., more patients per day. But that’s not a sustainable business practice and certainly not an acceptable care model.


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    PCPs report that they must see about twice as many patients as a few decades ago in return for the same income. If a PCP needs to see 24 to 30 patients per day, then a patient has a 15-20 minute visit with actual face time of about one half of that. This is long enough for a simple problem, but much too short for someone with a complex issue, or someone with multiple chronic diseases and taking multiple prescription medications. It is certainly not long enough for an elderly person with impaired vision, hearing or cognition and not enough when the problem has an underlying anxiety.

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    • UBM User
      I agree, the fix to the PCP crisis is simple. If primary care physicians were paid on par with specialists, there would be no shortage.
    • [email protected]
      Until recently, I have worked in large health systems in rural areas. We have had difficultly recruiting primary care physicians despite higher than average compensation. Many of the candidates we ultimately hire are not US educated. The "best and the brightest" are not going into primary care despite a desire to do so. Many of those physicians I've spoken with are concerned about student loan repayment and having the quality of life seeing more patients would bring. Add a rural living environment and most pass on these areas where PCP's are desperately needed. I disagree that shifting money is the best option to grow the pool of PCP's. Of course, it would help, but that only tightens an already scare resource. It's time to consider loan forgiveness for those entering primary care. We should consider options where a student focuses on primary care or internal medicine and serves in rural or health professional shortage areas (or the VA, FQHC) for a 5 year period (or other agreed upon time frame), the physician can have the government reduce or pay off their loans. Physicians, like anyone else, are motivated by incentives. If, as a nation, we can incentivize physicians to enter into this field, it is a win-win.
    • [email protected]
      Improving the supply of PCP and the quality of primary care seems very simple to me. The medical education system should be training fewer specialists and more PCP's. Perhaps we need fewer residency positions for sub-specialty training. Of course, PCP's would also prefer better compensation. I think health insurers must reduce the amount of bureautic red tape and EHR's should be standardized with fewer proprietary obstacles to improve efficiency. We need to move toward an efficient, uniform manner of handling medical information. I understand that some may be anxious about these suggestions since they might tend to move the healthcare system away from capitalism. We need a better public health message informing the public about core health issues. I also think patients need to be held accountable for the decisions they make. It is not unreasonable to consider reducing entitlements to Individuals making poor health choices. Thank you for considering my ideas and I am interested in yours.
    • UBM User
      In last 8 years there has been too much interference by government and government related paperwork that has burned out many qualified doctors. Excellent and experienced primary care doctors are replaced by many non doctors and care is actually getting more fragmented, there are more referrals to specialists and more tests done for no reason giving rise to higher cost of care. We must get rid of idiotic, mandatory, punitive and useless requirements like PQRI, PQRS, MU1, MU2 AND NOW MIPS OR MACRA. I don't know which "smart" non-working doctors are advising our law-makers!

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