Revitalizing Primary Care, Part 1: Root Causes of Primary Care's Problems.

Area of Science:

• Health Services Research
• Health Policy
• Primary Care Medicine

Background:

• Primary care in the United States faces significant challenges impacting its overall health and sustainability.
• Key issues include a disproportionately low percentage of national health expenditures allocated to primary care services.
• Clinicians often manage excessively large patient panels, leading to burnout and compromised patient access.

Purpose of the Study:

• To identify and discuss the root causes of primary care's systemic problems in the U.S.
• To analyze the relationship between primary care spending, patient panel size, and clinician well-being.
• To lay the groundwork for proposed solutions to revitalize primary care.

Main Methods:

• Analysis based on personal clinical and policy experience.
• Incorporation of evidence summaries and data from Organization for Economic Co-operation and Development (OECD) countries.
• Qualitative data from visits to numerous practices and interviews with hundreds of healthcare professionals.

Main Results:

• In 2016, the U.S. allocated only 5.4% of health expenditures to primary care, below the OECD average of 7.8%.
• Average U.S. primary care panel sizes necessitate unsustainable workloads (approx. 17 hours/day) for clinicians without adequate team support.
• Underfunding and unsustainable work-life balance discourage medical students from pursuing primary care careers.

Conclusions:

• Revitalizing U.S. primary care necessitates fundamental changes, including increased dedicated funding.
• The creation of robust, team-based care models is essential to manage large patient panels effectively.
• Addressing these core issues is crucial for improving clinician sustainability and patient access to care.