The first step in transforming health care is to re-examine the role of America's physicians. (Photo credit: Army Medicine)
The Affordable Care Act is designed to increase the nation's supply of health insurance coverage. Meanwhile, America's aging population is increasing the demand for health care services.
As a result, our nation is likely to face a physician shortage as detailed in last week's article ' Doctor Debate: Too Many American Physicians or Too Few? '
But this problem cannot be solved simply by training more physicians. If the U.S. chose to address the increased demand for medical care by adding doctors, offices and hospitals, the costs would be unaffordable. And even if we decided to do it anyway, it would be a decade before these newly trained physicians would be available to satisfy today's increasing demand.
The only tenable option: Change the way physicians practice. Do more with what we have. And do it better. Here's how:
Rebalancing The Ratio Of Specialists And Primary Care ProvidersIn general, the more medical and surgical specialists in a community, the higher the frequency of procedures performed, the greater the complexity of interventions they recommend, and higher the total cost of health care. The Dartmouth Atlas has consistently demonstrated these relationships and their consequences.
In most industries, added supply leads to lower costs. But in health care it leads to supply-induced demand.
The problem is that not only do these borderline interventions significantly raise cost, but this extra medical care fails to translate to better health outcomes, as well.
One need only look back on Atul Gawande's 2009 piece ' The Cost Conundrum ' for insight into the skewed cost/quality equation in health care. Through this lens, we now know that physicians in some geographies perform many more spine surgeries and hysterectomies than in others. Yet their patients don't live any longer or any better.
In fact, the U.S. ranks first in the world in the proportion of specialists to primary care physicians but nowhere near the top in measures that deal with the quality of outcomes.
Rebalancing the ratio of specialists to primary care providers is an essential first step toward improving quality while managing costs.
Increasing the number of primary care residency spots while proportionately reducing the number of specialty training positions would be a viable start. But at the same time, we need to make the practice of primary care more attractive for medical students. To do that, we will need to shift both the pay scale for the primary care physicians and the way primary care physicians practice. The good news is that both are possible.
Primary Care Providers As Drivers Of Improved Outcomes And Reduced CostsPrimary care physicians are the first point of contact for people with undiagnosed health concerns. These physicians also provide continuing care for certain chronic medical conditions.
And for patients with complex medical problems, primary care physicians can bridge knowledge across different organ systems, avoiding the likelihood of patients 'falling through the cracks' as they are handed from one specialist to the next.