Tuesday, May 13, 2008

How Did This Article on Primary Care Access Get Past the Editors at Health Affairs?

Check out this article (or abstract) published in the ‘web part of Health Affairs. Dr. Colwill and colleagues tapped into U.S. census data and matched up the projected increases in the nation's various age groups versus the supply of primary care physicians. As you would guess, the authors found that by the year 2025 (or 20 dash 25, see below), the shortage of PCPs will be worse than anyone anticipated.

Colwill et al found the U.S. population will increase by 18% and that the number of persons age 65 years or more will increase by 73%. If the various age segments continue to seek PCP care at the same rate they do today (1.5 visits for those less than age 65, about 3 visits for those older than age 65), it’s projected that there will be a 29% increase in the work load for the average adult care generalist. Unfortunately, the current pipeline of generalists, even with an expansion in the number of medical schools, can only produce an 11% increase.

In their Discussion segment, the authors review the limitations of their analysis and recognize that physician supply is dynamic, that demand could increase if universal health insurance occurs or, alternatively, decrease if the number of uninsured grows.

But it's the ‘policy implications’ section of the paper that is a whopper. Noting that greater 1 on 1 doc-patient efficiency is unlikely, that tapping into the non-physician (NPs or PAs) supply is a limited strategy, that specialists’ track record in primary care is dubious and that concierge medicine limits access, the authors laud the ‘medical home’ as an answer to our nation’s health care dilemma. That’s because, as everyone apparently knows, the medical home is efficient, provides access, increases everyone’s satisfaction and reduces spending.

Oh? Is that why the Medicare Program needs to demo it first? Why insurers are still piloting them? The Disease Management Care Blog agrees the Medical Home has considerable merit but isn’t sure it’s ready for the big time or that it can be held up as a single solution to the looming generalist shortage.

What surprises the DMCB, however, is that the editors of Health Affairs allowed this scholarly work on physician supply to turn into a sparsely referenced mini-editorial on a distantly related topic. It’s also depressed by the lack of equal time for the solutions offered by disease management. Once again, one approach to care that could efficiently ‘off-load’ a segment of chronic illness care away from the overstretched primary care community goes unmentioned by our friends in academia.

Now that the DMCB has gotten that off his chest, it’s time to feel even better by breaking into song. With apologies to Zager and Evans and their 1969 hit 2525…..

In the year 20 dash 25,
If doctors can survive
Medicare can’t deny
They may find…..

In that year 20 dash 25
Ain’t gonna get to see your doc, ain’t no jive
Should have believed that Health Affairs
It's bye bye to my elder care

Oh I fear 20 dash 25
How ‘bout that Med’cal Home, or will I die?
Specialists are bein’ forced on me
My treatments are from just NPs

It just sucks 20 dash 25
Doc just won’t take my call, yet I try
How will I stay alive, oh I’m screwed
Primary care is gone and woe, I lose!

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