The Future of Health Care May Be Primary Care

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Dr. Mintz has a well thought out blogand I commend him for that. I realize that he is writing aboutsomething that is near and dear to him and that he is passionateabout. I am sad to disagree in part with him, but my side is fromthe patient side and I need to express my thoughts accordingly.
Dr. Mintz is one of a dying breed ofdoctors. He is primarily involved in the world of academia since heteaches medicine. He makes valid points in his three areas used todeclare primary care is the future of healthcare. 1. Primary Care is High Value Care.2. Primary Care is Critical in ReducingWaste.3. Increasing Technology and Access toInformation Requires Navigation and Experience.
There are several points that he hasmade in prior blogs that invalidate his points. First, with thepresent and increasing shortage of primary-care doctors, how canprimary care become the future of healthcare? The American Academyof Family Physicians (AAFP) wants us to believe that they are,“Ensuring a Quality, Physician-led Teamfor Every Patient.” They claim, “TheU.S. is moving to a new primary care model built around patients anddelivered by teams, known as the Patient-CenteredMedical Home (PCMH).” Unless they can turn the tide ofdoctors leaving the primary-care profession and encourage morestudents to enter the primary-care profession, what Dr. Mintz issaying will have no meaning.
There will not be enough primary-caredoctors to provide leaders for the PCMH. In addition, they arecutting off their own hands to see that others do not lead theseteams. Nurse practitioners (NPs) are capable, but the AAFP does notsee this and strongly opposes this happening. The Institute ofMedicine (IOM) disputes the claims of patient safety concerns by theAAFP and labels them unfounded. In fact, the IOM says NPs are on apar with primary-care physicians. The arguments set forth by theAAFP continue – lack of training, lack of experience, nurseshortage and others. Even the other medical organizations arestating positions against allowing NPs to head up PCMHs.
An important fact that many areoverlooking may be the best argument for allowing NPs to be in thesepositions is the cost savings. “There isevidence that primary care by nurse practitioners is less costlybecause they tend to order fewer tests and expensive diagnosticprocedures than do physicians. Thus, there still may be cost savingsfrom nurse practitioners even if they are paid on a par withphysicians for the same services.” Considering theprevious statement, we need to wonder if primary-care physicians area small part of the $750 billion waste in healthcare spending.
Then we also have this to consider, “Inaddition, some observers argue that physicians are overqualified forsome of today's primary care work, which can involve routine physicalassessments and ongoing care rather than diagnosis and treatment ofcomplex conditions.” This could also be a strongincentive to give nurse practitioners an increased role in theprimary-care arena.
Please read my blog here that containsother information on nurse practitioners.