Articles
A Relationship Worth Preserving: Do Not Let the System Come Between You and Your Primary Care Physician
Marilyn Malia, D.O.
Recent surveys indicate a concerning trend: a significant percentage of young adults lack a primary care physician! One survey showed that thirty-three percent of North American adults ages 18 to 34 do not have a primary care physician.¹ Another poll conducted in the United States in 2019 found forty-five percent of individuals ages 18 to 29 had no primary care physician.² This lack of connection with primary care can lead to missed opportunities for preventive care and negatively impact long-term health. The value of a strong doctor-patient relationship, especially with a family physician, cannot be overstated. The continuity and coordination of care offered by a primary care physician have intrinsic value. Numerous studies support the objective benefits of increasing the number of primary care physicians in a given area, from county-level comparisons to international findings. These investigations reveal the following observations:
Having a Primary Care Physician Nearby Saves Lives!
Research consistently demonstrates that increasing the supply and concentration of primary care physicians saves lives. For example, a 2018 JAMA study showed that an increase of 10 primary care physicians per 100,000 people was correlated with an increase in life expectancy of 51 days.³ A 2005 literature review pointed out that an increase of one primary care physician for a population of 10,000 led to a 6 percent decrease in the population’s overall mortality rate.⁴ Conversely, decreased availability of primary care physicians is linked to higher mortality rates across a diverse range of populations.
Primary Care Physicians Find Cancer Earlier!
Early detection is crucial in cancer treatment, and primary care physicians play a vital role. For instance, melanoma, a type of skin cancer, can often be recognized by primary care physicians at an early, more treatable stage.⁵ ⁶ Routine physical exams and the integration of skin microscopes (dermatoscopes) to screen for skin cancer in primary care settings enhances the evaluation of suspicious lesions. This facilitates early detection, biopsy, and identification of both aggressive and indolent skin cancers.
Family physicians also improve the odds of identifying colon and breast cancer in their early stages by educating and encouraging routine screening evaluations for selected populations. Individuals with high-risk attributes can be identified and screened at a younger age when appropriate.⁶ Moreover, family physicians play a crucial role in managing conditions that increase the likelihood of cancer developing. They also help during cancer treatment by managing other conditions such as heart disease and diabetes effectively, which can contribute to better outcomes.
Family physicians are often the supportive voice for healthy lifestyle habits, including smoking cessation and weight loss. The benefits of quitting tobacco are well-documented, including a reduction in cancer incidence and improved cardiovascular health. Weight loss has been shown to decrease the incidence of endometrial cancer and type II diabetes. The long-term relationship a patient develops with their primary care physician offers the ideal avenue for providing this essential aspect of care.
Primary Care Physicians Send You to the Right Place at the Right Time!
Family physicians possess a broad scope of practice and can evaluate complaints with a wide differential in mind. They are trained to address diverse pathologies, incorporate interdisciplinary knowledge, and coordinate specialist care. Primary care physicians can also help prevent unnecessary healthcare visits. In fact, specialist performance has been shown to improve when they receive referrals from primary care physicians instead of self-referrals.⁷ This is achieved through in-depth evaluations in the primary care setting, the resolution of minor illnesses with minimal intervention, and the initiation of targeted work-ups when a specialist is needed. In some cases, a primary care physician can provide care and avoid sending routine issues to a specialist when it is not needed.
For All These Reasons and More, Primary Care Physicians Save Money!
By decreasing mortality, increasing early cancer detection, and providing thoughtful referrals, family physicians save money, time, and resources. They also facilitate cost savings by performing procedures in less expensive environments. The comprehensive nature of primary care leads to decreased hospitalizations and fewer emergency department visits, which are significantly more costly than visits to a primary care clinic.
This is a Vital Relationship to Foster!
Many young adults are increasingly reliant on urgent care, telemedicine, and self-treatment options. While the convenience of these alternatives is appealing, it comes with potential costs. Establishing a relationship with a primary care physician can empower and inform care within an increasingly complex healthcare system. It’s a relationship that provides protection, not only from serious health conditions but also from excessive testing and unnecessary costs. The return on investment in a relationship with a primary care physician is evident in the many forms of prevention it promotes.
References
1 Glauser W. Primary care system outdated and inconvenient for many millennials. CMAJ. December 2018. 190(48):E1430–E1431. doi:10.1503/cmaj.109-5688
2 Bhuyan N. Millennials don't have PCPs; here's why they should. American Academy of Family Physicians. https://www.aafp.org/news/blogs/freshperspectives/entry/20181022fp-millennials.html October 22, 2018. Accessed November 20, 2019.
3 Basu S, Berkowitz SA, Phillips RL, et al. Association of primary care physician supply with population mortality in the United States, 2005-2015. JAMA Intern Med. April 2019. 179(4):506-514. doi:10.1001/jamainternmed.2018.7624
4 Hartz A, James PA. A systematic review of studies comparing myocardial infarction mortality for generalists and specialists: lessons for research and health policy. J Am Board Fam Med. June 2006.(3):291–302.
5 Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly. 2005. 83(3):457–502.
6 Ferrante JM, Gonzalez EC, Pal N, Roetzheim RG. Effects of physician supply on Early detection of breast cancer. J Am Board Fam Pract. December 2000. 13(6):408-14.
7 Franks, P, Clancy CM, Nutting PA. Gatekeeping revisited - protecting patients from overtreatment. N Engl J Med. August 1992. 327(6):424-9.