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Goodbye to primary care as we've known it | Viewpoint


The relationship with your doctor is giving way to advanced practice providers, apps, and telemedicine services. Who is coordinating all this to ensure high-quality care?

Peter Bonis (Photo: Wolters Kluwer Health)

Peter Bonis (Photo: Wolters Kluwer Health)

Your primary care doctor just retired after 20 years. Now what?

If you’re lucky, you were referred to a trusted colleague and find a timely appointment. For most, however, finding a replacement is getting much harder.

Options for many of us, especially those outside major cities, are becoming increasingly limited. According to the U.S. Department of Health & Human Services, as of its September 2022 report, 97.6 million people now live in what is defined as a Health Professional Shortage Area (HPSA). And the situation is worsening; the Association of American Medical Colleges forecasts a primary care physician shortage of between 17,800 and 48,000 by 2034.

Whether or not you live in a HPSA, you’ve likely witnessed how healthcare is changing. The one doctor-one patient, single point of coordination is vanishing. New care delivery models are evolving based on teams of healthcare professionals, within retailers (such as CVS, Walgreens, Walmart, and others), and using varied digital options. The relationship with your doctor is giving way to relationships with advanced practice providers (such as nurse practitioners and physician assistants), institutions, apps, self-monitoring technologies, and telemedicine services.

Who is coordinating all this to ensure safe, consistent, high-quality care? We already know that primary care doctors have too few hours in the day to deliver all the guideline-recommended care, much less adopt approaches to advance precision and preventative care that consumers want.

Will this evolving system give a boost to consumer-friendly, affordable, accessible, high-quality care, harm it or both? And how should consumers navigate through the changes? Finally, what is being lost when the covenant of a long-term, human-to-human care delivery model yields to a more modularized and distributed one?

We do not yet have answers to these questions, but the industry is already responding. The wealthy are turning increasingly to concierge medicine practices to retain a primary care model, but the expense is prohibitive for most people.

Technology is advancing that permits unimpeded flow of healthcare data across care delivery settings. This will help, but only if that information is delivered in a way that helps busy healthcare professionals care for patients. Healthcare systems are re-engineering approaches to care services to ensure repeatable, high-quality, well-coordinated and affordable care. Payment models are evolving to have increasing sophistication and market leverage to measure and finance the needed changes.

But all of this will take time. For now, most of us do not have much flexibility to decide where and how we get care; insurance plans, costs, and accessibility of locally available resources continue to be dominant considerations.

Ultimately, each of us must quarterback our own care and that increasingly no longer involves a primary care provider. Indeed, the percent of Americans who have a primary care provider is declining, and is lowest among healthy young people. Overall, about 30 percent of patients who received medical services did not visit a primary care provider, suggesting that primary care is regularly bypassed. Yet, all of us need a partner who can help us translate rapidly evolving medical knowledge into the long view to help us stay healthy and manage our problems along the way.

The U.S. healthcare system is evolving. There will be growing pains and we must navigate with open eyes and strive not to go it alone.

Dr. Peter Bonis is the chief medical officer at Wolters Kluwer Health and serves as an adjunct professor of medicine at Tufts University School of Medicine.

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