For several weeks, the bumpy rollout of the federal health insurance marketplaces has overshadowed almost all other health care topics. But after reviewing the timely Health Affairs issue dedicated to the health care work force, it is clear we must maintain our focus on building a primary care system of the highest quality and value. Within that increasingly complex system, primary care physicians are the first, most critical line of defense.
The Affordable Care Act puts more emphasis on primary care and preventive care than ever before. It’s an upfront investment in better health down the road for our patients. Already, many of those patients are quite sick with multiple chronic conditions. In 2010, 45 percent of adults in the United States had two or more chronic illnesses, and trends in pre-diabetes and obesity suggest that number may still increase. With medical advances and sicker patients, primary care has become more important and more complicated than ever before.
With that in mind, this month’s Health Affairs issue really spoke to me. Articles extensively addressed the shortage of physicians in our country, speaking to the value we add in primary care. An important element of that, which tends not to get addressed upfront, is how to make sure an increasingly complicated population of patients gets the right care.
One way, as my colleague Dr. Scott Shipman of AAMC pointed out in Health Affairs, is to reallocate more time from administration to patient care. He wrote that if we shifted certain administrative responsibilities from physicians to non-physicians, we could add an additional 30 to 40 million physician visits each year. That would help ensure that physicians’ training and time get put to the best use: helping our patients tackle their increasingly complicated health care challenges.
We can also make more efficient decisions about who provides care, and when. I am team-based care’s number one fan. I know all of the health professions have important yet unique roles to play and we all bring our own strengths to the team. Patients don’t always need the same team members for every medical issue. More cost-effective delivery models such as team-based care increase the number of patients a physician serves — and help us serve each patient better.
However, more patients having complicated cases of overlapping chronic conditions means more complicated decisions about patient care and treatment. It takes a physician’s comprehensive education, training and experience to make the right call about who has the requisite experience and skills to best serve each patient. And getting it right the first time is best for the patient and for the health system overall.
Family physicians are trained to serve as team leaders, not to just follow treatment and diagnostic protocols. To get to this point in my practice, I completed more than 20,000 hours of training and education, learning to provide the best care to patients despite a wide array of complex variables. I can’t imagine doing my job without this intense preparation.
Training and expertise is critically important because primary care has never been more challenging. Patients gaining health insurance for the first time face disproportionate challenges compared to the general population. In the midst of this influx of patients, many of whom already have multiple chronic conditions or are on track to develop them, the availability of physician expertise in a team-based environment is becoming more important, not less.
As we move forward with health insurance and health care system reforms, primary care physicians and the teams of non-physician providers we work with every day are critical to meeting our communities’ growing health challenges.
Reid Blackwelder is president, American Academy of Family Physicians.
