Let primary care physicians be chronic care specialists

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We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist.

That is, provided the PCP has the time to care for his or her patients with chronic illnesses.

PCPs are skilled at managing, for example, diabetes with complications, heart failure, chronic lung diseases, hypertension, and obesity, among many others. They see patients with these illnesses in their practice daily, so their experience level is high. Sure, the organ or disease specialist is needed some of the time but not all that often when an experienced primary care physician is at the helm.

All too often, under today’s practice pressures to see too many patients per day, the PCP does not have adequate time to practice as this chronic disease specialist. If there are only ten minutes and the situation is the slightest bit complicated, the tendency is to refer the patient to the specialist. This, of course, drives up cost but does not drive up care quality. Much better if the PCP were to see fewer patients per day — yet retain the same income — and then offer those patients the high level of care that he or she is actually capable of delivering.

How can this be done? There are many ways. Just substituting “value” is not the way. It requires insurers to pay more per visit, or more per capitated individual with the understanding that the patients will get whatever time is needed. It means that employers can offer to pay the membership or retainer of the direct primary care physician (a.k.a. membership, concierge) or establish a clinic with PCPs who are not overburdened. It means individuals can seek out a PCP who limits his or her practice to about 500 to 700 individuals (instead of the usual 2,500 to 3,000) and visits to 8 to 10 per day instead of 25 or more.

This type of primary care costs more, no question about it. But the benefits are clear. The PCP can be the chronic care specialist and with that comes better care quality, less physician and patient frustration, greater satisfaction and much reduced total costs of care. It’s worth considering.

Crisis-2 jpegStephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO, University of Maryland Medical Center, and senior advisor, Sage Growth Partners.  He is the author of Fixing the Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor.

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