My distractions

Family Medicine Rocks!

written by Matthew Rensberry, MD MBA on 2015-08-17

As a Family Medicine doctor, I have some pride in my specialty and am likely a bit biased over the benefits Primary Care Physicians (PCPs) provide to individuals. Today, I thought I would look up evidence on those benefits. To say I was surprised is an understatement. I was blown away at the evidence supporting Family Medicine's benefits to individuals, populations, and healthcare systems!

In 2005, a paper was published by B Starfield, L Shi, and J Macinko titled, "Contribution of Primary Care to Health Systems and Health." (Download here)

It starts off with some background and some interesting history. Some of this background:

The Institute of Medicine defined primary care as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community."

Primary care services are divided into:

  1. First-contact access for each new need
  2. Long-term person (not disease) focused care
  3. Comprehensive care for most health needs
  4. Coordinated care when it must be sought elsewhere.

How well a PCP fulfills these services is how well they are as a PCP.

PCPs are:

This publication then goes on to cite many studies demonstrating in many way how higher ratios of PCP to populations leads to lower all-cause mortality! This is in contrast to ha higher supply of specialty physicians has been demonstrated to increase mortality. In fact, one study referenced, which was performed here in Florida looking at cervical cancer, found a 1/3 increase in supply of FPs was associated with a 20% lower mortality rate - interestingly, this was not seen with an increase in the supply of OB/GYNs.

The authors propose 6 reasons which might explain the positive impact on population health that PCPs provide:

  1. Primary care increases access to health services for relatively deprived population groups
  2. Improved quality of care - specialists have inconsistent studies demonstrating better care for specific diseases, but when the interest falls not on the disease process or outcome but on the patient's health as a primary focus of health services - PCPs provide superior care. This is what we call whole person care.
  3. PCP concentration on preventive care.
  4. Addressing health problems earlier in their course - PCP's have the advantage of knowing their patients when they are healthy and identifying disease states before they increase in severity requiring a specialist in that disease
  5. Accumulated contribution of PCP characteristics to appropriate care - again, the focus of primary care is on the person, not the management of a specific disease only (like high blood pressure)
  6. The role of primary care in reducing unnecessary or inappropriate specialty care. There are definite needs for specialists (such as in uncommon disease states seen more often by a specialist or refractory disease states), but the appropriate patient selection and appropriate specialist use by PCPs improve population health.

I have always wondered why people criticize the US medical system when we obviously have the best resources in the World and I would prefer to be seen here over anywhere else for my own medical concerns.

This article sheds some light:

"Compared with other Anglophone countries, people in the United States experience more adverse effects and medical errors. This, combined with evidence concerning the adverse effects of greater supply of specialists and estimates of the likelihood of adverse effects of medical care, may at least partly explain the United States' low ranking on health status relative to that of similarly industrialized countries."