Primary Care Physicians 'Powerful Force for Good,' Says Keynote Speaker

Primary care physicians provide the highest level of quality at the lowest cost of any health care professional group in the country, putting them in a strong position to lead health system change, said internist Roger Merrill, M.D., during the keynote address at the Opening Ceremony of the 2009 AAFP Scientific Assembly here on Oct. 14.

Merrill is chief medical officer at Perdue Farms Inc., which operates on-site primary care medical clinics at virtually all of its 18 major facilities in 12 states. The clinics serve as patient-centered medical homes for about 22,000 Perdue employees and their family members. Employees and their dependents can access the clinics when they are at work and are charged a small copay that is deducted from their salaries.

Merrill said Perdue applies a health-conveyed-per-dollar methodology to the provision of primary care services. He pointed out that only 5 percent of the nation's health care costs are spent on primary care, but primary care physicians are on the front lines of the health care system, treating and managing chronic diseases before they become acute. This provides enormous cost and health benefits to society at large, he said.

"When you look in the mirror in the morning, you are looking at the most powerful force for good in the country," Merrill told attendees. Primary care physicians may consider themselves to be at the bottom of the food chain, because everyone makes more money than they do, but they actually are at the top of that chain, said Merrill. "You are where the action is. You control where your patients go. Your patients have a relationship with you that they don't have with any other provider."

Yet, employers and insurers consistently undervalue primary care, which has led to a shortage of primary care physicians, said Merrill, who noted that medical school graduates are not choosing to become primary care physicians and, instead, are opting for more lucrative subspecialties.

"This is not a test of how devoted our children are to medicine or to health," Merrill said. "It is an intelligence test. About the third year of medical school, someone comes up to a medical student and asks, 'Would you rather be a radiologist for $750,000 a year or a primary care doctor for $125,000 a year?'

"People who flunk that quiz become family doctors," he joked, prompting laughter from the audience. "But that makes no sense -- it makes no sense that we allow that to drive the most important medical specialty in America."

Merrill asked his audience what happens when subspecialists deliver primary care. "(Sub)specialists do special stuff," he said. "That special stuff is typically more expensive and less effective than what you do as you administer to your patients."

The chronic shortage of primary care physicians has created a health care system that is plagued by increasing costs and decreasing quality, according to Merrill. "Nations with higher proportions of primary care doctors and higher numbers of primary care doctors per square inch or per population have better health and lower costs."

According to Merrill, Perdue has found that having a primary care physician infrastructure to take care of its employees increases their quality of care. As part of its proactive health improvement system, the company sends nurses and other health care professionals out into the plants to check blood pressure, cholesterol levels and the weight of every employee. This enables the company to acquire a snapshot of the health status of their employees and to provide interventions to help employees with chronic conditions.

The company's investment in primary care has paid off handsomely. In the United States, the American Diabetes Association says the number of people with well-controlled diabetes is about 37 percent, said Merrill. Among employees with diabetes who participate in Perdue's health improvement program, that proportion is 75 percent.

The numbers are even more dramatic for employees with hypertension. Thirty-four percent of people with hypertension in the United States are controlled to standard, compared with 80 percent of Perdue employees who are enrolled in the health improvement program, Merrill said.

"It is all about money," said Merrill. "Increasing reimbursement for primary care doctors is an appropriate tool on the way to improved health for our citizenry."