An excerpt from Medical Answers Now!: How Direct Primary Care Guarantees Fast Access to Your Doctor.
Medical doctors practicing as primary care physicians (PCPs) are the only physicians who deliver all of the following five major benefits of a primary care relationship to their patients. All five of these aspects of care are required for any person to receive well-coordinated overall medical and preventive care with a high level of continuity of care in the most efficient and cost-effective manner possible.
What are these five benefits and why are they necessary for the best quality healthcare?
1. Address the Vast Majority of Healthcare Needs
Primary care physicians are able to address and solely manage the vast majority of healthcare needs. In a study in JAMA Internal Medicine (2012), researchers estimated that more than 90% of concerns that are brought to primary care doctors are successfully dealt with without the need for referral to any specialist physician. Due to the broad training and scope of practice of primary care physicians, most personal health needs are appropriately and efficiently handled by a patient’s primary care physician.
As the first point of contact, primary care physicians initially address all problems and health questions that patients may have. While it is unfortunately not common knowledge in the general public, primary care physicians have no restriction as to the problems or organ systems that they address, and they are comfortable diagnosing and treating acute illnesses, chronic disease processes, and the most common injuries.
Primary care physicians are experts in all common physical, mental, emotional, and social concerns. They have the appropriate training to manage a large majority of problems in their offices and only involve specialists for further evaluation or treatment when requested by the patient or when it is deemed necessary by the physician and in the best interest of the patient.
2. Provide Continuity and Accountability
Primary care physicians uniquely provide continuity of medical care and accountability to their patients for their current and long-term health. Specifically, this benefit of primary care is the continuity that comes from an ongoing relationship and rapport with a physician who knows their patients’ entire health and personal history. Over multiple years treating the patient, the physician develops a context for optimal care and possesses an accumulated personal health record to better evaluate each new concern and manage any chronic conditions.
As, inevitably, patients require some specialty care by other physicians and healthcare providers, their primary physician makes referrals, is aware of the assessments and treatments by the specialists, coordinates care of multiple providers as needed, and (maybe most importantly) serves as a translator for complicated and technical information and medical terminology that specialists may not have time to communicate adequately to the patient.
In addition, the primary care physician assumes a proactive role of responsibility and accountability for ongoing care and decision-making about their patients’ health, self-care, preventive care, and ongoing medical management. In optimal circumstances decision-making and accountability are shared with the patient in a very real sense. This kind of ongoing relationship with a primary care physician over the years is invaluable and cannot be approximated by isolated encounters with telemedicine or urgent care doctors.
3. Address Proactive Preventive Care
Primary care physicians know that longevity and quality of life are directly linked to proactive preventive care. Patients who are engaged in a long-term relationship with a primary care physician are more likely to be advised about and pursue healthy lifestyle choices, risk factor reduction measures, and timely screening for hidden medical risks and impending medical conditions. In most cases, these disease prevention and early detection measures have a greater impact on overall health than do interventions for acute illnesses.
HEALTH RISK MODIFICATION: Periodic discussions about health goals with this trusted medical adviser allow patients to understand health risks better and encourage them to make lifestyle choices that are proven to improve quality of life and delay or prevent a myriad of medical disorders. It is common knowledge that tobacco use (smoking, chewing, and now nicotine-containing vaping), excessive alcohol consumption, illicit drug use, poor diet, lack of exercise, and overweight/obesity are the leading modifiable risk factors for disease and premature death.
Doctors know that pills are easy and lifestyle changes are hard. The value that primary care physicians provide are centered around personalized explanations about the reasons that healthy lifestyle prolongs life, the importance and impact of patients’ choices, advice on practical tips to making change happen, and repeated encouragement over time.
TIMELY PREVENTIVE SCREENINGS: Another major area of preventive care is screening for hidden disease and risk. The primary care physician advises and reminds patients concerning preventive screening guidelines that, when followed, result in early detection of disease and improved health outcomes.
Research has shown that regular primary care visits are associated with an increase in recommended preventive interventions including an increase of 127% for vaccinations, 122% for colonoscopy, and 75% for mammography. Many categories of health screenings are recommended based on the patient’s age and existing risks. Screenings of patients who are completely without symptoms frequently uncover issues related to virtually every organ system and significant medical conditions. People who do not undergo these screenings often have advanced issues including cardiovascular diseases, cancers, metabolic conditions, and countless other potentially life-threatening problems by the time symptoms are present and diagnosed.
4. Help Patients Navigate the Healthcare System
The American healthcare system is complex and confusing. Individuals who have a reliable relationship with and timely access to a primary care physician are more likely to utilize healthcare services appropriately, efficiently, and cost-effectively. Utilizing their primary care physician as a health services concierge, they are less likely to require secondary care from specialists including emergency room visits, urgent care, telemedicine services (with an unknown doctor/nurse), or care delivered by various specialist physicians.
Patients who first consulted their primary care physician are also felt to have utilized emergency department care less often for COVID-19 concerns. The physician educates their patients about recommended facilities for ancillary services (imaging, physical therapy, sleep labs, for example) and advises them about cost-effective approaches to purchasing prescription medications, among other health-related direction.
There is an alarming variation in prices for medical services among various facilities. Imaging studies such as x-rays, CT scans, and MRIs may often be obtained for cash prices that are significantly less than many patients’ copayments under their insurance plans. And simply by making effective prescription medication choices and coaching their patients on how to receive discounted cash pricing on their medications, primary care physicians may save their patients more than the total cost the physician charges for delivering their care.
5. Provide Better Health with Lower Cost
Reliable access to primary care has proven to result in improved health outcomes and overall healthcare cost savings. Better access to primary care and a greater number of primary care physicians in a geographic area are associated with improved health status and lower mortality rates.
Multiple studies performed across the United States have shown a consistent relationship between the ratio of primary care physicians to the population as the only consistent predictor of age-specific mortality rates, and mortality associated with cancer, heart disease, neonatal mortality, and life expectancy.
While delivering improved health outcomes, primary care is widely recognized to simultaneously reduce overall healthcare costs by means of all the benefits listed in this chapter. Healthcare costs go down when medical conditions are detected early and managed efficiently by primary care physicians. Costs also go down when unnecessary overutilization of expensive specialty and emergency care is contained or eliminated and when care is delivered by the least expensive medical providers and institutions. Primary care is inherently less expensive than the care delivered by specialty physicians and institutions that provide secondary and specialty care.