Primary care physicians are never happier with their medical career choice than when they are spending time with patients. But balancing care for complex patients with administrative demands is one of their toughest tasks, according to primary care physicians who were interviewed for a recent report.
The report by the Commonwealth Fund, "Is Primary Care the Best and Worst Job in Medicine?"(features.commonwealthfund.org) examines the level of job satisfaction of primary care physicians in the United States and United Kingdom. The physicians surveyed said their profession is highly rewarding, but many are weary of demands imposed by reporting requirements and the limited support insurers provide to care for increasingly complex patients.
The report emphasizes the importance of primary care to public health. But author Brian Schilling notes that the fee-for-service model rewards expensive procedures over primary care, and he examines how new payment models can change that.
Bolstering support for primary care is critical.
- A recent report from the Commonwealth Fund examines the level of job satisfaction among primary care physicians in the United States and United Kingdom.
- Many of their answers reflect the reality that AAFP President Wanda Filer, M.D., M.B.A., sees in her practice.
- Initiatives meant to increase physician satisfaction and improve patient care may require more time to show their effectiveness.
"Studies have consistently found that in regions with higher ratios of primary care physicians to residents, mortality rates from heart disease, cancer and stroke all tend to decline," the report states. "Infant mortality and low birthweight rates drop, as well."
Primary Care Requires Broad Resources
Physicians who were interviewed expressed frustration with resources available to support better health outcomes, including care coordination and connections to community services for patients who are homebound.
AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., told AAFP News that she understands this sentiment. It is a key driver of advocacy work by the Academy and by individual members to win proper support for primary care.
"It's true that an awful lot is being dropped in the lap of primary care," said Filer. "And we are trained to handle it, but not without resources."
Filer said she is seeing more patients who need assistance with housing, healthy food, medication bills and out-of-pocket costs for physical therapy.
Oftentimes a patient's social needs are just as great as their physical health needs. Filer recalled one patient with diabetes who was nearly blind and at risk for injury from falling into the holes in the floor of her home.
"We are graded on controlling diabetes, but we need to fix the holes in her floor so she does not end up in the ER," said Filer. "We have to pay for complexity of care and whole-person care."
A huge challenge for many primary care physicians is trying to meet patients' mental health needs. One quarter of U.S. primary care physicians said their practices were unprepared to care for patients with severe illnesses or overlapping chronic conditions, according to the Commonwealth Fund report. Family physicians across the country tell Filer the volume of patients with such complex needs is increasing.
Scheduling a referral for psychiatric care can take seven months. But despite the rising need for mental health coordination and new payment policies to support it, many U.S. insurers will not pay for a mental health consult that occurs on the same day as a primary care visit, a policy Filer called "absurd."
Team Environment Benefits Patients
According to the report, physicians who work in a team environment with sufficient administrative support are more likely to enjoy their work because their practice model makes interacting with patients the priority. One physician said this arrangement allows him to focus on "high-level medical decision-making."
Filer has found success in such a system. Recently, for instance, she was unable to see a patient who had been discharged from the hospital after being treated for multi-organ system failure. Instead, a physician assistant (PA) conducted the visit and learned that the patient had received several prescriptions for which no explanation was given in the hospital record. The PA consulted with Filer, and they decided to keep her on the medication for six weeks.
"The PA did a fabulous job working outside of her comfort zone," Filer said. "Because of the conversation we had, we were able to improve access for the patient."
New Initiatives Address Challenges
Among primary care physicians in the United States, 54 percent said the time spent on administrative tasks is a major problem. U.S. physicians are spending a whopping $15.4 billion annually tracking quality measures and reporting them to insurers, according to the Commonwealth Fund report. And the digital tools that should be saving them time often make their job more difficult.
According to Filer, medicine is the only profession whose members adopted new technology and then had to hire additional staff -- such as medical scribes -- because the new tools made simple tasks more time-consuming.
The Commonwealth Fund report noted that new initiatives regarding payment, technology and recruiting need time to show their effectiveness, and it concluded optimistically: "With time, these efforts may lead a new generation of physicians to understand what many know already: Primary care is among the most rewarding careers available in medicine."
The Commonwealth Fund
In the Literature: Primary Care Physicians in Ten Countries Report Challenges Caring for Patients with Complex Health Needs(www.commonwealthfund.org)
(Dec. 7, 2015)