Primary care in the United States accounts for more than one-half of all outpatient visits. Moreover, regardless of the clinical models, primary care is at the core. Unquestionably, primary care is at the center of health equity and preventive care. However, it receives a relatively modest proportion of resources, possesses no federal coordinating capacity, no dedicated research support, suffers a declining workforce pipeline, and remains inaccessible to large portions of the population.
If we are to place primary care as the keystone to our care, it’s imperative first, to define the primary care physician’s role as well as the essential primary care services. In addition, there is a difference between the services that are needed, their provision, and the payment mechanisms. Currently, the focus of a significant portion of the daily activities of the primary care physician is on items that could be distributed to others in a team-based approach. Primary Care Teams, including the appropriate clinicians, not just primary care physicians, should be able to deliver primary services. Payment models should evaluate and disseminate payment based on the ability of such models to promote the delivery of high-quality, holistic care.
Investment is also necessary to ensure primary care is accessible to all. Whether a payment differential is paid by location, telehealth, the utilization of community health centers that serve as a local hub, or new models such as school-based clinics, we need to solve the issue of primary care distribution.
Additionally, research is necessary to determine the best primary care methods and the optimal delivery modality. Underfunding primary care research leaves us questioning what works and what does not. Moreover, it’s essential to decide whether there is a genuine shortage of primary care physicians or simply a distribution issue. Hence, it is necessary to query ourselves whether we require services of our primary care physicians that would be better managed in a more team-based approach?
Concurrently, if we need a more distributed primary care workforce, how does educational debt play into the conversation? Although physician pay is drastically different for specialists than primary care physicians, the cost of education is not. Unfortunately, medical school education is set upfront before the decision of one’s career is decided. Taking this one step further, an intriguing model would be to scale educational costs based on the income earned during one’s career.
Regardless of the situation or solution, if we believe in the importance of primary care, we need to reaffirm our commitment to a strong foundation of high-quality primary care as a common good, accessible to everyone. Thus, our focus and attention are necessary at the federal level. As we focus on our infrastructure, let us contemplate how primary care is at the center and invest accordingly.