Averting the Collapse of Primary Care in America

By Robert G. Strickland, MD, FACP

We are on the verge of a looming crisis in adult primary health care in this country. Without a major change to our health care system there will not be enough primary care physicians nationally or in New Mexico to take care of an aging population with increasing occurrence of chronic diseases.

Today, New Mexico has 256,744 Medicare beneficiaries, and that number is increasing. In 1985 New Mexico had only 150,354 Medicare beneficiaries. According to the Bureau of Health Professions, New Mexico's population over age 65 is projected to grow by 74 percent between 2000 and 2020.

Also according to the Bureau of Health Professions New Mexico had only 62 active primary care physicians per 100,000 population in 2000. And, according to the AMA's Physician Characterisitics and Distribution in the U.S., in 2003 37 percent of the 5, 031 physicians in New Mexico were over the age of 55 and approaching retirement.

Primary care is an essential component in the overall care of our aging population. Recent studies in both JAMA and Health Affairs have shown that primary care physicians help to provide higher quality patient care at lower costs. However, in order to take advantage of the quality that primary care services provide, patients need to have access to primary care physicians.

It is astounding to learn that medical student interest in careers in primary care medicine is decreasing dramatically. According to a study published in Academic Medicine in 2003 only 27 percent of third-year internal medicine residents intended to pursue careers in general internal medicine, down from 54 percent in 1998. More recently it was found that less than 20 percent of first-year internal medicine residents reported that they were planning primary care careers.

In addition, dissatisfaction of the practice environment is leading general internsists to leave primary care practice. A study published in the January 3, 2006 issue of the Annals of Internal Medicine after 12 or 13 years in practice 21 percent of general internists are working in a field other than internal medicine, while only 5 percent of internal medicine specialists have left their chosen specialty.

The American College of Physicians (ACP) is a national organization of internists - both general and subspecialty physicians - who specialize in the prevention, detection and treatment of illnesses in adults. ACP has developed a comprehensive plan of action to reverse the downturn in primary care medicine before it is too late.

"National Workforce for Internal Medicine," one of the ACP policy papers, calls for a national health care workforce policy to reverse the impending collapse of primary care. Without a strong primary care system, ACP believes the consequences will be higher costs and lower quality of patient care.

"Redesigning Internal Medicine Training," another ACP policy paper, recommends a system of educating medical students and internal medicine residents to more effectively meet the needs of patients and of 21st century medicine within the context of a rapidly evolving system of health care delivery.

"Reforming the Dysfunctional Payment System," ACP's third policy paper, addresses the challenge of a payment system that does not support the value of skills and quality care that primary care physicians provide. This proposal addresses the way that Medicare fees are determined, how payments are updated, and how to assure that pay-for-performance programs provide sufficient incentives for quality improvement and care coordination by primary care physicians.

A final policy calls for a new model of patient care. This model is based on the premise that the best quality of care is provided through patient-centered, physician-guided, cost-efficient, longitudinal care, designed to strengthen and support the patient-physician relationship. Under the model, patients would have a personal physician - most likely a primary care physician or a specialist/subspecialist for patients requiring ongoing care for certain conditions - working with a team of health care professionals in a practice that is organized according to the needs of the patient.

ACP believes that redesign of internal medicine training, reform of the dysfunctional payment system and implimentation of the advanced medical home practice model will reattract medical students to primary care careers, reverse practice dissatisfaction of working internists, and ensure the return of a health care system capable of responding to the health care needs of our rapidly aging population.

Robert G. Strickland, MD, FACP is Governor of the New Mexico Chapter of the American College of Physicians and former chairman, Department of Internal Medicine at UNM School of Medicine.

Page updated: 05-26-06

What's New

Contact Information

Michael H. Kaufman, MD, FACP, Governor, New Mexico Chapter

Sylvia Burns
Chapter Administrative Assistant
Office: 505-962-0358
Fax: 505-962-9221
E-mail: nmacp@msn.com