The primary care model needs to be tailored to provide efficient, high quality care . Under the most common applications in the market it does neither.
Medical information doubles every 12 to 18 months. Primary care doctors have the herculean task of keeping up in every field which is impossible. Specialists have only their discipline within which to stay current. The more fundamental question is whether every patient needs to be seen by a board certified generalist or specialist on first presentation.
Well known facts
The vast majority of diagnosis which present to physicians are self limited and require no immediate intervention or aggressive workup
Over 80% of visits to physicians are followups or routine monitoring of known diagnostic conditions which almost certainly can be performed with high quality and efficiency by advanced care providers eg HTN , cardiac, diabetes, pulmonary/asthma etc.
Over 60% of ER visits are for nonemergency conditions. Clearly the the triage does not always require a board certified ER physician. A perfect example is my son being seen by an ER trained PA for a wrist sprain after trauma. She did a complete and thorough history, exam and ordered an xray without the involvement of the doc who checked her work and signed off on the case in 90 seconds.
Independent practice units have neen proffered as a multidisciplinary solution to disease specific management which bypasses the primary care model for all existing conditions and the work up of specific symptoms…back pain, headaches, knee pain etc
Team based care with primary care physicians supervising/overseeing care are being increasingly used and popular with patients
Using advanced care providers with subspecialty training in all specialties is the model for future care. Ortho, endocrine, cardiovascular, neuro, dermatologic, ob, etc trained NPs, PAs can provide excellent care and when needed refer to primary care or specialty MDs
Time to tweak and revamp a primary care delivery model which is anachronistic. Burnout is epidemic in primary care because it is a model domed to failure due to unrealistic expectations that generalists can remain state of the art for all symptoms, diagnoses and disease management .
Generalists are invaluable in the work up of diagnostic dilemmas and their skills can be critical in the management of patients with elusive diagnosis and who fail conventional work up. Typical examples would include , abdominal pain, weight loss and a host of other conditions which do not neatly fall into a subspecialty designation
If you are seeking to change your delivery model, the time is now!!
Copyright NicolasArgy 2019