Vinod Kurup

Hospitalist/programmer in search of the meaning of life

Sep 9, 2006 - 2 minute read - Comments - informatics medicine

Is Primary Care Dying?

Dave referenced an interesting article in the NEJM titled “Primary Care – Will it Survive?" These two quotes summarize the problem:

A 2006 report from the Center for Studying Health System Change reveals that from 1995 to 2003, inflation-adjusted income decreased by 7.1 percent for all physicians and by 10.2 percent for primary care physicians.


It has been estimated that it would take 10.6 hours per working day to deliver all recommended care for patients with chronic conditions, plus 7.4 hours per day to provide evidence-based preventive care, to an average panel of 2500 patients (the mean U.S. panel size is 2300).

Compensation is down and responsibilities are up. I’ve been especially aware of this as more than a few of my colleagues have left, without being replaced. So not only do we have more to do per patient, we have more total patients per doc. This will worsen as the population ages. These conditions are leading to a decrease in the number of students and residents who choose primary care, which of course creates a vicious cycle.

One of the interesting solutions proposed in the article was a heavier use of web-based solutions:

A more thoughtful solution to physicians' time constraints requires a combination of team care and electronic encounters. Nonphysician team members working with Web- and e-mail- based patient portals can perform routine preventive care functions and manage less complex chronic care. However, forging cohesive and efficient teams is a challenge, and few payers adequately reimburse these services.

I’m interested in creating those types of solutions. The problem is that when you use these solutions and begin to speed up patient care, the temptation will be to increase the number of patients seen, rather than to spend more quality time with each patient. If you do that, you begin to break the doctor-patient relationship - a relationship that is more valuable than the purely technical aspects of care alone.