When it comes to saving American lives, don’t look to cardiologists, oncologists or even the made-for-TV heroes in the ER. It’s primary-care providers who offer the best hope of reversing the devastating decline in U.S. life expectancy.
That finding comes after decades of research — and mounting frustration — from health-system experts who have argued for more investment in the accessible, comprehensive, community-based services that allow countries with far fewer resources, including Chile, Costa Rica and Portugal, to make gains while the United States founders in the survival stakes.
Without patients having access to primary care, minor complaints evolve into chronic illnesses that demand complex long-term treatment plans. Addressing basic patient problems in the emergency room costs up to 12 times what it would in a primary-care office, resulting in billions of additional dollars each year.
But even as evidence mounts that access to primary care improves population health, reduces health disparities and saves health-care dollars, the field is attracting fewer and fewer medical students. The remaining small-group medical practices are being replaced by concierge offices with steep annual membership fees.
In response, the Department of Health and Human Services is making a commitment to strengthen primary care for all Americans and has been soliciting input from health-care providers, unpaid caregivers, health technology developers and others to establish what role the government can play. And in September, Sens. Bernie Sanders (I-Vt.) and Roger Marshall (R-Kan.) announced a $26 billion bipartisan bill aimed at expanding primary care and reducing staffing shortages.
Meanwhile, the business of primary care is in upheaval, with investors banking on integrating the historically fragmented industry with pharmacy and specialist care.
Giant retailers including Amazon, CVS and Walmart are spending billions of dollars to enter the market, promising to transfer their trademark online ordering and one-stop shopping to primary care. And venture capitalists are investing rapidly in value-based care, a model that reimburses providers based on positive outcomes rather than rewarding them for treatment they offer after patients fall sick.
All of which puts a big question mark over the future of primary care.
“Who is going to win this race? I don’t know,” said David B. Nash, a physician and professor of health policy at the Jefferson College of Population Health at Thomas Jefferson University in Philadelphia.
“Can America improve health? That’s the key question.”
The problems undermining primary care were exacerbated by the coronavirus pandemic, according to a report by the Commonwealth Fund, a nonprofit that supports research on health-care issues. But the erosion had been underway for years. From 2005 to 2015, the prevalence of primary-care physicians in the United States fell by 11 percent, from 46.6 to 41.4 doctors per 100,000 people.