Apr 22, 2019 • Longeviti

Primary Care Physicians Increase Life Expectancy and Keep Healthcare Costs Down. We’re Losing Them!

The failure to fairly value the practice of primary care for its superior performance in reducing healthcare costs and helping patients live longer, healthier lives is accelerating the decline in the number of primary care and family practice physicians.

Perception is not reality

American medical culture is laboring under the false perception that doctors who deliver immediate results are more worthy of respect  (and compensation) than those who successfully focus on the long-term health and wellness of their patients.

“…if Patient X lives until his nineties, no one can be sure whether he would have had a heart attack or developed cancer without the work of his primary care doctor. By contrast, when a cardiac surgeon unblocks the blood vessels to the heart or a general surgeon successfully removes a large tumor, Patient X knows exactly who saved him.”

Therefore, Americans label cardiologists and neurosurgeons as “life savers,” but not the primary care doctors who keep them off the operating table in the first place.

Robert Pearl, M.D.

The International Journal of Health Services published the findings of a study titled, “Primary care, specialty care, and life chances.” The study’s conclusions had the potential to revolutionize US healthcare.

The researchers determined:

• “primary care is by far the most significant variable related to better health status,” correlating with lower mortality, fewer deaths from heart disease and cancer, and a host of other beneficial health outcomes.

• By contrast, “the number of specialty physicians [i.e., surgeons, cardiologists, orthopedists, etc.] is positively and significantly related to total mortality..”.

These findings suggest that the allocation of healthcare resources in this country is so misconceived, it may even be detrimental to our health.

“From a policy perspective, a likely implication is to reorient the medical profession from its current expensive, clinically based, treatment-focused practice to a more cost-effective, prevention-oriented primary care system,” according to the study’s research abstract, which was published July 1, 1994.

Wait! That was 25 years ago…?

We know the medical establishment tends to be conservative and that’s a “good thing.” We don’t want our physicians prescribing us the latest “wonder drug” or switching to “trendy” treatment modalities based on the conclusions of a single study making miraculous claims.

That said, this reluctance to change even when change is supported by “good data,” looks irresponsible. We are talking about 25 years!

A more recent Harvard-Stanford collaboration, (February 18, 2019, in JAMA Internal Medicine) led by Dr. Sanjay Basu, examined life expectancy rates in the United States from 2005 to 2015.

The team found:

• Adding 10 primary care physicians to a population of 100,000 delivered a 250% greater increase (+ change) in life expectancy than that generated by an equivalent increase in specialists.

• When looking at the overall U.S. population, the density of primary care physicians declined by 11% between 2005 and 2015, falling from 46.6 to 41.4 per 100,000 people.

This study confirmed the relative value of primary care established in the 1994 study and went on to look at certain structural defects in our current primary care system. These included physician reimbursement and residency training.

In a Stanford press release, Basu predicted that “despite the clear correlation between better health and primary care, the number of primary care physicians is likely to continue to decline.” 

Why we’re losing or primary care/family practice doctors

It’s just a fact that our existing base of primary care physicians (PCPs) is aging rapidly and in too many cases, is retiring from practice. That would be manageable, were there a sufficient number of new physicians entering primary care practice to replace them. There isn’t!

They are not being replaced

If you were a young doctor at the end of your internship and looking to choose and be accepted into a Residency program, you might well have the following on your mind:

1. The need to repay  a “terrifying” education loan debt ($300-500k, not uncommon!)

2. Specialists’ average annual salary is 50+% higher vs. primary care physicians!

• Primary Care: $223,000
• Specialists (Other): $329,000
• Orthopedic surgeons: ~$500,000 half-a-million dollars annually.

3. Finding a Residency in Primary Care is becoming increasingly difficult.

Follow the money

Residency training programs are incentivized to produce more and more specialists each year as opposed to the PCPs we need.  Not surprisingly, the reason is money!

• US Residency training programs are run by hospitals and funded by Medicare with the hospitals getting paid the same amount for administering the programs whether they train primary care residents or specialists.

• The health insurance system in the U.S. pays out much higher reimbursements for complex, expensive, hospital-centered treatments (e.g., surgeries, hospitalizations) than for preventative and primary care.

• It is in the hospitals’ financial self-interest to train more specialists like orthopedic surgeons and fewer primary care practitioners.

 Solutions?

There are plenty of opinions among healthcare industry “leaders,” U.S. legislators, and the medical establishment regarding our ever-increasing healthcare costs, yet most fail to recognize the vital contribution made by Primary Care and the significant cost savings to be had by ensuring PCP’s are present in the system in sufficient numbers.

Stopping the hemorrhage

Unfortunately, the critical shortage of primary care physicians cannot be easily detached from the larger struggle over the future of the US healthcare system.

That said, since we do know that primary care physicians help keep healthcare costs down and that having more of them in practice helps us to live longer, healthier lives, we can demand that our policy-makers incorporate those insights into their planning.

To that end, they need to:

• acknowledge and develop an offset for the medical student “debt bomb” that is strongly discouraging young doctors from embracing lower paid, primary care/family practice

• structure residency programs to ensure hospitals train enough primary care and family practice physicians to stop to their decline and rebuild their numbers

• restructure insurance and Medicare reimbursements to more accurately reflect the indispensable contribution primary care physicians make to the long-term health and well being of both their patients and the overall healthcare system.

There are also thoughtful solutions offered by primary care physicians. They have the greatest insight into the issues involved and deserve to be heard and not drowned out by the hospitals, insurance providers, pharmaceutical companies, medical device makers and the more politically connected.