By Glenn Sabin, Co-authored by Taylor Walsh
Reading the striking 80-plus-page report, Meeting the Nation’s Primary Care Needs, led by Dr. Michael S. Goldstein from UCLA’s Center for Health Policy Research and John Weeks, executive director of Academic Consortium for Complementary and Alternative Health Care (ACCAHC), made clear to me that the tipping point for integrative medicine as the standard of care is nearing.
The Goldstein/Weeks report, published by ACCAHC, is responsive to innovative care structures emphasized in the Patient Protection and Affordable Care Act (PPACA) meant to address the state of primary care in America. With the provisions of the PPACA set for full enactment in January 2014, there is a lot of discussion about how the approximately 30 million newly insured Americans will access primary care. The looming question is: “Who will deliver it?”
But before we explore the potential impact of the PPACA and the implications of the Goldstein/Weeks whitepaper itself, let’s first examine some important facts surrounding primary care.
More than 70% of Chronic Disease is Preventable, but Practical Solutions to Reverse the Trends Remain Non-Reimbursable
Lifestyle modification and behavioral change education almost never happens in a conventional PCP setting. Most doctors were not taught the basics of lifestyle medicine during medical school. The government’s current concept of prevention needs redefining. Physicians are largely treating disease symptoms, not causes, and are often too quick to prescribe drugs during their short patient visits. Simply and sadly put, this is because patient education and lifestyle counseling take time and is not reimbursed through our current payer model.
Shortage of Primary Care Physicians (PCPs)
The Association of American Medical Colleges warns that we could be short nearly 63,000 physicians across specialties by 2015. PCPs are expected to account for a large percentage of this unmet need. Many PCPs are retiring. In several markets, large and rural, affluent and underserved alike, PCPs are not taking new patients.
Primary Care Physician Burnout
PCP burnout is at an all-time high, with growing pressure to see more patients each hour just to keep their doors open. They are largely unhappy with the medicine they are delivering. Many are considering quitting.
Lack of Financial Incentives
Reimbursements from third-party payers (i.e., private insurance, Medicare) continue to decline, resulting in mounting financial pressures for existing practitioners. Many PCPs are closing shop or being acquired by hospital systems across the country.
The Shrinking Pool of Physicians Entering Primary Care
Newly minted MDs are largely avoiding paths to primary care largely because of the compensation issue. They have massive student loans to repay and realize that over the course of a PCP career they will earn several millions dollars less than their specialist colleagues. These more lucrative specialties also typically involve a lot less off-hours patient calls.
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