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Primary care physicians (PCPs) and clinicians have traditionally been the first line of care for patients, from preventive care to chronic condition management to urgent needs, and their work is rooted in the trusting, lifelong relationship they build and maintain with their patients. The reality of this ideal vision is that access to primary care is heading towards crisis in the current health care environment.
Insufficient supply of PCPs
As a nation, we’re facing a decreasing supply of primary care doctors that is projected to reach a shortage of more than 55,000 PCPs by 2033. Aging baby boomers have drawn providers toward coordinated care, and far fewer medical students are choosing a career in primary care. And PCPs still in practice face major challenges:
Mary Mulcare, MD, FACEP
- Higher patient volume reduces time spent with patients. Today's 15-minute visits might check the right boxes in a templatized electronic medical record system, but they fail to build and leverage the long-term patient relationships that are central to primary care. Significant time constraints limit active listening by a PCP to get at the "why" behind health concerns to facilitate more effective diagnosis and care.
- Growing administrative responsibilities. PCPs are tasked with greater administrative, reporting, and billing responsibilities that limit patient time, contributing to increased cost. Many primary care doctors feel their ability to deliver the care they are trained to do is limited and, in some cases, diminished by these competing demands on their time.
- Shrinking reimbursement rates. Under the proposed 2024 physician fee schedule, PCPs will see a 3.3% reduction in reimbursement for Medicare patients. This and other financial pressures incentivize medical students to choose more lucrative specialties and cause many current PCPs to sell their practices. According to the American Medical Association, fewer than half of physicians work for physician-owned practices.
- Evolving financial risk models. With the Centers for Medicare and Medicaid Services pushing all Medicare beneficiaries to a value-based arrangement by 2030, the health care system is making an undeniable move toward capitation and other shared-risk models. As a result, PCPs will face greater financial complexity and assume greater financial risk, without adequate infrastructure.
- PCP management of chronic conditions. In the U.S., 60% of adults have at least one chronic condition, and 25% of U.S. adults are on five or more prescription medications. PCPs are often the default doctor for these patients and others with diabetes, heart disease, obesity, and other long-term conditions. These conditions require education, guidance, lifestyle changes, behavioral health management, and consultation with appropriate specialists. PCPs shoulder much of the burden of condition management and coordination of care, often without the necessary feedback loops to make informed patient-specific decisions.
The reality is this: Trusted relationships with PCPs are vital to the health care system. We need to rethink our model of primary care.
Fast access to specialist expertise is a gamechanger
Most specialists are concentrated at academic medical centers in major cities, limiting access to their unique expertise for many – including PCPs. But these limitations can be eliminated by efficient, scalable technology.
Virtual specialty care is a gamechanger. With access to a network of specialists for peer-to-peer e-consultations, PCPs gain accelerated access to specialist expertise, helping them to make quicker diagnoses and better treatment decisions to retain long-term, trusting relationships with their patients.
This potent integration of the PCP’s trusted relationship and the specialist’s deep subject matter expertise can make health care dramatically more efficient and effective. In Kaiser’s remote-specialist model, PCPs supported with a peer-to-peer connection to specialists were able to provide treatment 40% of the time without the need to refer their patients for an in-person specialist appointment.
How peer-to-peer e-consults work
To support powerful collaborations between primary and specialty care doctors, the best peer-to-peer technology solutions offer synchronous and asynchronous communication across many different channels. Such a system allows doctors to choose the best communications format based on case urgency and complexity. For straightforward questions like medication titration, a text message may suffice, whereas a complex condition, such as back pain, might require a video consultation.
For the most serious cases, a PCP might also choose to connect patients directly to the specialist for a virtual consultation. In this scenario, the patient gets answers to all their questions and gets a clear path for treatment, but information from the visit is easily available to the PCP so they can ensure continuity of care.
The benefits of specialist expertise are powerful, and long-term
When PCPs can connect with specialists easily, quickly, and at the point of care, their work is more impactful and rewarding, and they bring even greater value to the doctor-patient relationship:
- Timely care decisions. PCPs retain their place as the medical home for their patients, and they can focus on coordinated, comprehensive, and patient-centered health care for the whole person.
- Integrated care. PCPs can connect with specialists over several, successive consultations or messages. Depending on the complexity of a patient's case, they might share medical records and test results, or collaborate on treatment plans. This streamlined opportunity for ongoing communication with specialists ensures continuity of care.
- Cost control. With ready access to specialist expertise, PCPs can reduce the need for costly in-person referrals and are better positioned to support the upcoming shift to value-based models. When an in-person specialist visit is needed, PCPs can coordinate with a specialist to ensure that testing, data collection, and other preparatory work is completed in advance of the referral visit. The result is quicker, less expensive, more effective care.
- Greater patient satisfaction. Patients of PCPs who use peer-to-peer e-consults benefit from the deep expertise of specialists without the inconvenience of additional doctor visits and referral waiting periods. In addition, many out-of-pocket expenses (including travel and specialist copays) are eliminated, which can save hundreds of dollars for each visit. Taken together, these and other benefits deliver a better health care experience for patients.
PCP support is foundational to transforming the future of health care
Supporting PCPs with access to peer-to-peer e-consults from a network of specialists provides a powerful, easy, and cost-effective method to prioritize the patient-provider relationship in primary care – and most importantly, allow primary care doctors to excel in their critical and unique role in the health care system.
Mary Mulcare, MD, FACEP, is the chief medical officer at Summus and oversees all clinical aspects of operations. She also serves as a clinical assistant professor of emergency medicine at NewYork-Presbyterian/Weill Cornell Medicine, and has held several leadership roles at Weill Cornell. She served as chief resident of the emergency medicine residency program at NewYork-Presbyterian Hospital and completed a fellowship in geriatric emergency medicine at Weill Cornell Medical Center.