Letter from Your Doctor

It is a war zone out there. If you think I am talking about Covid-19 or politics, I am not. I am speaking of the practice of medicine. It is a war we are losing…badly!

Covid-19 and the presidential elections seem to be taking up all the media’s time. As a result, you will probably never hear about the changes taking place in the practice of medicine.

Our healthcare system is dying, and the patient is presenting with far advanced disease. If we do not act quickly, our nation’s healthcare system will be jeopardized. The bedrock of our healthcare system, and entrée to the system, is the primary care physician.

When someone says, “my doctor,” he/she is most likely referring to his/her primary care physician. The primary care physician is generally the first doctor seen in the patient’s journey and the physician most responsible for following a patient’s chronic conditions. One’s primary care physician is likely the first person a patient asks for help with anything medical.

A primary care provider is the physician who not only knows the most about the patient and the patient’s past medical history, but also the patient’s unique characteristics, family, and social circumstances.  The primary care physician cannot be replaced by a nurse practitioner or a physician’s assistant. These latter individuals may supplement a physician’s advice but can never replace a physician’s depth of knowledge, training, or experience.

The primary care physician is the gateway to the rest of the medical system. Whether one needs radiological studies, such as MRIs, CT scans or x-rays, or referrals to other physicians such as surgeons or specialists, the primary care doctor is there to map the course. In addition, the primary care physician is also available to the patient to explain the results of tests from other physicians and integrate the findings into the patient’s overall care.

The bedrock of our healthcare system, and entrée to the system, is the primary care physician.

A primary care physician’s job is not easy or glamorous. The mighty primary care doctor is not usually the one giving interviews or press conferences. They primarily work in the background making sure that patients have the best outcome possible.

The demise of the primary care physician, particularly the private primary care doctor, has been slowly taking place for many years. The reasons are many and far beyond the scope of this article. Covid-19 has accelerated the death blow to primary care.

It is necessary to review some statistics in order to understand the dying process. If patients do not come into the office to be seen, the physician does not get paid. Primary care physicians’ consultations in the second quarter of the year were down 21.4% from the prior second quarters of 2018 and 2019. Office based visits were down 50.2%. Telemedicine was up remarkably, going from 1.1% of visits to 35.3% when compared to 2018 and 2019. But have you ever really tried to examine a patient via video? Most people do not have their own blood pressure machines. Therefore, you might not be surprised that blood pressure assessment was down 50.1% when compared to the comparable periods in previous years. People cannot have their cholesterol checked on a tele-visit. Cholesterol assessment are down 36.9% when compared to previous years.

You could say that, but you would be wrong. We are now in the last quarter of the year and the frequency of physician visits is not bouncing back. Primary care doctors were surveyed in September and their response was frightening. “Eighty-one percent of respondents to the survey disagreed emphatically that primary care has bounced back. 13% said things were better than earlier this year but not normal.” Add these together and an alarming 94% of physicians report that they are in deep trouble.

We must act quickly if healthcare is to survive. We must make sure that our primary care physicians have the resources and financial backing to survive.

Another national survey tried to ascertain if primary care physicians are leaving practice because of this pandemic. You may be surprised that 1 in 5 physicians said at least one clinician in their practice had opted for early retirement or left practice as a direct result of Covid-19. It is estimated that up to 35% of all private practice primary care physicians will be lost because of the consequences of decades of neglect of primary care and now, Covid-19.

The short-term effects of the exodus of primary care physicians will be to shift the massive burden unto our urgent care clinics, emergency rooms and hospitals. As the situation worsens, people may get frustrated and simply not get care at all. As it stands now, many people are not getting routine care, resulting in increases in morbidity and mortality. Thirty-five percent of excess deaths seen during this pandemic are not caused by the virus but are attributed to treatable disease like heart disease, high blood pressure and diabetes.

One can scream about various political answers but every political answer from the right and the left depends on a healthy pool of primary care physicians to take care of our population. Everyone wants easier access and better outcomes. But without the primary care physician there is no access to care and health outcomes suffer. We need to realize that the start of the solution depends on the exact individuals we are driving away.

We must intervene and we must act quickly if healthcare is to survive. We must make sure that our primary care physicians have the resources and financial backing to survive. Our primary care physicians are drowning in regulations, ever-increasing costs, and lack of time. We must incentivize our younger physicians into the amazing field through loan forgiveness, financial incentives, and escape from regulatory purgatory. We must aid them with human and computer resources to streamline care that will not cripple them with monetary burdens they cannot afford.

This is not just a doctor problem; this is a problem for each and everyone of us. If we want the healthcare we deserve, we better start demanding our primary care physicians are taken into consideration. Without them, no solution will work.

Reed S. Wilson, MD

I am extremely interested in your responses. You can write me at [email protected] or [email protected]

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Many people ask me how they can make a difference. Each of you can be making people aware of the problem and forwarding the information to those who make decisions. Each person you talk to may be the one that leads to change.