December 5, 2012

The Future of Health Care May Be Primary Care

Dr. Mintz has a well thought out blog and I commend him for that. I realize that he is writing about something that is near and dear to him and that he is passionate about. I am sad to disagree in part with him, but my side is from the patient side and I need to express my thoughts accordingly.

Dr. Mintz is one of a dying breed of doctors. He is primarily involved in the world of academia since he teaches medicine. He makes valid points in his three areas used to declare primary care is the future of healthcare.
1. Primary Care is High Value Care.
2. Primary Care is Critical in Reducing Waste.
3. Increasing Technology and Access to Information Requires Navigation and Experience.

There are several points that he has made in prior blogs that invalidate his points. First, with the present and increasing shortage of primary-care doctors, how can primary care become the future of healthcare? The American Academy of Family Physicians (AAFP) wants us to believe that they are, “Ensuring a Quality, Physician-led Team for Every Patient.” They claim, “The U.S. is moving to a new primary care model built around patients and delivered by teams, known as the Patient-Centered Medical Home (PCMH).Unless they can turn the tide of doctors leaving the primary-care profession and encourage more students to enter the primary-care profession, what Dr. Mintz is saying will have no meaning.

There will not be enough primary-care doctors to provide leaders for the PCMH. In addition, they are cutting off their own hands to see that others do not lead these teams. Nurse practitioners (NPs) are capable, but the AAFP does not see this and strongly opposes this happening. The Institute of Medicine (IOM) disputes the claims of patient safety concerns by the AAFP and labels them unfounded. In fact, the IOM says NPs are on a par with primary-care physicians. The arguments set forth by the AAFP continue – lack of training, lack of experience, nurse shortage and others. Even the other medical organizations are stating positions against allowing NPs to head up PCMHs.

An important fact that many are overlooking may be the best argument for allowing NPs to be in these positions is the cost savings. “There is evidence that primary care by nurse practitioners is less costly because they tend to order fewer tests and expensive diagnostic procedures than do physicians. Thus, there still may be cost savings from nurse practitioners even if they are paid on a par with physicians for the same services.” Considering the previous statement, we need to wonder if primary-care physicians are a small part of the $750 billion waste in healthcare spending.

Then we also have this to consider, “In addition, some observers argue that physicians are overqualified for some of today's primary care work, which can involve routine physical assessments and ongoing care rather than diagnosis and treatment of complex conditions.” This could also be a strong incentive to give nurse practitioners an increased role in the primary-care arena.

Please read my blog here that contains other information on nurse practitioners.

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