Robert Graham Center: Policy Studie...

Robert Graham Center: Policy Studies in Family Practice and Primary Care Washington, DC

John Hopkins University Bloomberg gymnasium of Public Health Baltimore, Maryland

EDITOR'S NOTE: This editorial is being republished with corrections to Figures 1 and 2

In this issue of American Family Physician, the series of One-Pagers (1-3) from the Robert Graham Center put forward evidence that a primary care workforce crisis may formerly again be taking shape. The 1990 saw alignment of public policy and funding efforts to increase the primary care workforce, and indeed family medicine training capacity grew at 34 percent. (4) U.S. medical learners responded, and the primary care physician workforce increased, on the other hand the growth of the subspecialist workforce still out-stripped that of primary care physicians. Since 1997 U medical drill graduate matches in family medicine and general internal medicine programs have fallen by way of nearly 50 percent. Despite the disproportionate extension of sub-specialties, U.S. primary care physicians still provide greatest in quantity of the care to chiefly patients for most conditions principally of the time.

fresh efforts to frame physician work-force policies focus onward demand-based models (as opposed to need-based models) and put in mind of that as Americans' affluence rises, there will be a tint and cry for more subspecialty services. These proposals also remind of that primary care functions will be in les demand and that providers other than physicians will assume these functions. (4-6) It is important to recognize that what the market will bear may not be what the population can bear when it approachs to health care. The U health system's failure to adopt a primary care focus be the effects in poorer health outcomes for all Americans compared with our nation's industrialized fellows and at a much greater outlay Starfield and colleagues have compared the United States with other expanded countries and found that the United States ranked lowest in its primary care functions and lowest in health care issues but highest in health care spending (Figures 1 and 2) (7-10)

More than sum of two units decades of accumulated evidence reveals that having a primary care--based health method matters. People and countries with adequate access to primary care realize a number of health and economic benefits, including the following:

Evidence of Effectiveness

* Reduc all-cause mortality and mortality caused by means of cardiovascular and pulmonary diseases (11)

* Les use of crisis departments and hospitals (12,13)

* Better preventive care (1415)

* Better detection of breast cancer, and reduc incidence and mortality caused from colon and cervical cancer (16-18)

Evidence of Efficiency

* Fewer exhibitions higher patient satisfaction, less medication use, and lower care-related require to be paid [i]or[/i] undergones (19,20)

Evidence of Equity

* Reduc health disparities, particularly for areas with the highest income inequality, including improved vision, more clean immunization, better blood pressure rule and better oral health (21-23)

The United States leads the world in many ways: militarily, economically, and in health care spending. Health care spending of $17 trillion by means of year should be sufficient to place the United States in the lead in health and health care issues However, we find ourselves behind nearly all of our nation's industrialized comrades with regard to health issues We face another primary care workforce crisis that is settleed by increased diversion of medical denomination graduates into subspecialties. We appear to lack the political will to reorient our classification to primary care and to provide coverage and access to health care for all Americans.

The policy options for reorienting our health care rule to primary care have been forward the table for more than a decade (24) and include the following:

* Reimbursement that facilitates and rewards continuous, patient-centered, comprehensive, compassionate, and coordinated care; reimbursement that meditates the special challenges of primary care, fostering patient-focused continuity and maximizing quality and safety; and reimbursement that excites team practice and offers patients the expertise and training of each member rather than having them strive to fill the same roles

* Developing and supporting information rules and decision-support tools that help primary care physicians and their patients improve the quality of primary health care and to know when it is time to involve sub-specialists

* Using state licensing laws, population health destitutions assessments, and funding to shape an appropriate workforce

* Explicit subsidies for training programs that bring forth primary care physicians

* Expansion of loan forgiveness for primary care physicians

* Adequate support for practice-based research and primary care health services research

* Measuring and rewarding effective care, especially preventive care services

* Supporting better connections between primary health care, public health, mental health, and subspecialty services