How The Gatekeepers Conveniently Ignore The Solution For The Primary Care Shortage

There is a shortage of primary care physicians in the United States. The problem is worsening, and access to care bears tremendous importance to the patient. There are a steady stream of blog posts that are expressing their concern over the problem. If you didn’t know better, you would have to believe that the sky is falling and that universal health care (or some iteration of it) would break the back of the primary care physician population.

This has become an annoying issue in health care. At this point, I am really getting tired of hearing this. Frankly, the solution exists as we speak. Yes, the answer exists today. But it is being ignored by those who have a vested interest in the status quo – the gatekeepers themselves.

An effective system of health needs to have a means of getting the patient access to appropriate care.

A primary care physician’s practice is chock full of a variety of medical complaints – sore throats, the common cold, allergies, muscle strains, and the like. Many of these conditions can be appropriately dealt with by a nurse practitioner (NP). Let’s be serious – a patient with the common cold can be effectively screened (and treated) by an NP. That would be one solution to the primary care shortage.

Let’s extend this thinking even further. It has been noted that musculoskeletal disorders alone account for 10 – 15% of all primary care visits. There are 40 million Americans that have musculoskeletal disorders, and 70% of them are treated by a primary care physician. Houston et al (2004) noted that

“Although 90% of common nonsurgical orthopedic complaints are thought to be manageable in the primary care setting, the musculoskeletal exam and procedures are often inadequately performed by primary care physicians at all levels of training.”

Much the same way as an NP can effectively address a sub-set of conditions seen in a primary care physician’s office, a physical therapist can do so with musculoskeletal disorders. Again, let’s be serious – a patient with a muscle strain or acute back pain can be effectively screened (and treated) by a PT.

What makes it even more appropriate is that physical therapists are generally better trained than most primary care physicians in the assessment of musculoskeletal disorders in the first place.

As much as I respect and value the training of physicians, there are a large number of conditions that frankly don’t need their wisdom and problem solving skills. Let the physicians get on with using their skills to assess the conditions they need to assess. It would make physicians a lot happier to be focusing on the use of their skill set, and patients far greater (and ultimately more cost-effective) access to the appropriate care.

The solution to the primary care physician shortage – as it impacts patient access and care - already exists. Nurse practitioners and physical therapists could remedy the patient access issue immediately. It doesn’t require years of incremental change. It requires an elimination of the gatekeeper model. Let’s not fool ourselves in thinking otherwise just to maintain the status quo.

Reference: Houston T, Connors R, Cutler, N, Nidiry, M. (2004). A primary care musculoskeletal clinic for residents. Journal of General Internal Medicine, 19(5): 524-529.

Photo credits: kevin dooley