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BLOG: The case for primary care
In spite of the debate, drama and widespread awareness of the health care agenda in America, there has been no progress in resolving the most fundamental problem. This problem is the lack of resources for primary care services.
The Affordable Care Act (ACA), poised for repeal, actually did take some positive steps in this direction, according to the New England Journal of Medicine in its Health Policy Report in 2015 (Blumenthal et al.). Relative quotations from this work include: “The ACA has had its clearest and most measurable effects to date on the availability of health insurance to the American people and on their access to care… All told, more than 30 million Americans now have insurance under these new sources of coverage and consumer protections.”
Although we clearly have more of our citizens with coverage, it is not clear that this translates to true primary care that focuses on health education, wellness and prevention of the common chronic medical problems of obesity, hypertension and diabetes. This problem is not so much related to health care coverage as it is to the emphasis on the treatment of disease and the lack of providers to deliver this type of care.
In an important paper published by the Association of American Medical Colleges in April 2016, the scope of this problem is revealed: “By 2025, the study estimates a shortfall of between 14,900 and 35,600 primary care physicians.”
The answer lies in broadening the base of providers that provide primary care services and moving more of the health care dollar into this critical aspect of care. Yet movements in this direction are always going to end up in legislative battles and will be fought by many physician groups in spite of the obvious shortfall in physician numbers. Even nurse practitioners trained specifically in primary care will have to fight this battle, as noted in the Health Affairs, Health Policy Brief, “Nurse practitioners and primary care.”
For optometry, legislative efforts in each state must consider the public health need for expanded primary care services vs. further expansion into surgical eye care and laser procedures. State legislative committees and active state association members must ask themselves this important question before setting the legislative agenda: “In the past month in practice, did I see more patients that were obese, pre-diabetic, diabetic or with hypertension or more patients that needed a laser procedure?” And given the volume of these patients, “Does my state have the physician manpower to meet these needs of these patients?”
For the schools and colleges of optometry, it is important to consider the role of your future graduates in the health care system. Given the technology of the new millennium to perform the routine eye examination and evaluate and treat ophthalmic pathology, can’t our students spend more time on the prevention, diagnosis and management of the systemic pathology that leads to low vision and blindness?
My hat is off the optometrists in Kentucky that not only have passed legislation that allows optometrists to provide primary care, they also founded a new school with the primary care mission. In a February 2017 article in The Lane Report, the author notes, “In addition to providing eye and vision care, optometrists play a major role in patients’ overall health and well-being by detecting systemic diseases such as diabetes and hypertension, which affect a much higher number of Kentuckians than the national average.”
Primary care services, prevention and wellness on the front end and the aggressive management of chronic medical problems on the back end are the key to better heath for America and the fiscal solution to the American health care system. This care needs to be delivered by a broad base of health care providers that have easy and regular access to people where they live, work and play. Optometrists need to be part of this solution and need to take aggressive steps to move the profession in this direction.
References:
Association of American Medical Colleges. 2016 Update: The complexities of physician supply and demand: Projections from 2014 to 2025. https://www.aamc.org/download/458082/data/2016_complexities_of_supply_and_demand_projections.pdf. Posted April 5, 2016. Accessed August 28, 2018.
Blumenthal D, et al. N Engl J Med. 2015;372:2451-2458;doi:10.1056/NEJMhpr1503614.
Cassidy A. Health Policy Briefs. Nurse practitioners and primary care. Posted October 25, 2012.
Wollenhaupt G. The Lane Report. New Kentucky College of Optometry in Pikeville will help fill health care gap in Appalachia. Posted February 1, 2017.