The future of the Patient Protection and Affordable Care Act (ACA), also known as Obama Care, depends on  primary care physicians. This act, which was deemed constitutional June 2012, is going to change almost every aspect of the American health system. An estimated “32 million Americans will gain access to health care by 2019” (Goodson, 74). While this number is alarming, what is most alarming is the lack of primary care physicians the United States has. The amount of physicians today cannot provide quality care to this large influx of new patients. Obama Care intends to ensure a wider population of Americans by mandating everyone to be health insurance consumers. America’s new health care will focus extensively on providing preventative medicine. Other developed nations have a strong primary care physician workforce, yet America continues to favor specialized medicine. Medical research journals have noted that “robust primary care systems are associated with lower health care spending, reduced health disparities, and a higher quality of care”( Hofer, 71). If the ACA is to survive and uphold its visions, primary care has to be given a lifeline. To change primary care’s future we have to understand why so many medical students today are not going into primary care, what the ACA is doing to encourage residency numbers in primary care, and how the attitudes of young medical students about primary care are changing because of the ACA. If primary care is “the best cure for ailing the health care system” (ACP, 2), the ACA has to make sure all facets of its bill sections consider the future of primary care physicians.  

      Every year less and less medical students enter primary care residencies. Primary care physicians consist of: Family Practitioners, Internists, Pediatricians, and OB/Gynecologists. (ACP, 1) These physicians are characterized as primary care because they spend the most time “providing cognitive services, such as acquiring and assimilating information, developing management strategies, coordinating care, and counseling” (Goodson, 742). They are the holistic doctors that teach their patients and take time out of their day to not only diagnose the patient and provide treatment, but to counsel them when facing different stresses on their lives that could be affecting their mental health. As rewarding and intimate patient-doctor relationships are, American healthcare problems have caused a considerable shortage in primary physicians. Primary physicians today can be “aptly compared to a hamster on a treadmill, struggling to provide prompt access and high-quality care” (Bodenheimer, 2694). By not providing quality care that consists of having enough time for the doctor to listen to patient’s concerns and teach the patient, the primary care physician is stripped off an enjoyable aspect of practicing primary care medicine.

      Opponents of primary care claim that “more than 40% of primary care is given by specialists today” (Hofer, 71), and that expanding the funds for “primary care physicians is worthless to such an incompetent group of physicians.” (Gosh, 1) These claims are assuming that we have enough physicians to provide primary care. The reason so many people are receiving primary care from specialists is because there is a huge shortage of primary care physicians; therefore, patients seek primary care services from the vast majority of doctors, which are specialists. These people who are under the care of specialist are often patients whose illnesses became so severe that they had to seek medical help. Had they had a primary care physician in the first place, they might have been diagnosed earlier on and given preventative advice and medications to control their illness. Although it is true that many specialists are providing primary care, it does not mean that this is the best model for healthcare. This dilemma only further highlights our inability as a nation of providing adequate primary care and disease prevention before it gets out of hand. To those in the medical field that feel that primary care physicians are incompetent also emphasizes one of the largest problems in the medical community: respect. Many medical schools play little emphasize on the importance of primary care, and talk only of the prestige of the more compensated physicians. The level of disrespect and disdain given to primary care physicians by specialists throughout medical school education really perturbs medical students and even steers them away from applying to primary care residencies (Gosh, 1). The undermining of primary care doctors could not be farther from the truth, because they must “combine an exhaustive store of medical knowledge with ever-changing clinical trial data and practice standards within the unique bio-psychosocial situation of each patient” (Gosh, 1). These general practice physicians also make tremendous contributions to health policy, clinical research, and teach at medical schools since they have a wide breadth of clinical science knowledge and mentorship.

     Current reimbursement models have “contributed to the imbalance of generalists and specialists” (ACP, 3). Insurance companies pay by procedures and many duties of generalists are not procedural-based. Duties like counseling and educating the patient are not reimbursed because they are not procedures. The way reimbursements have been given has been attributed to the huge payment gap between primary care physicians and specialists. Primary care physicians “compensation has declined to levels that are 30% to 60% lower than those of specialists” (Goodson, 743). With a lower pay, students that choose to go into primary care fields repay their student loans slower and earn a lower income throughout their lifetimes. Lifestyle choices are also a big factor with this large discrepancy, because highly specialized physicians exert greater control over their lifestyles. American medical schools emphasize more specialty field and prestige of specialties. Unlike other developed nations, America “has 30% of the U.S. physicians practice primary care, whereas 70% are specialists.” whereas Britain that has “50% to 60% of physicians practicing primary care” (Goodson, 744). This large primary care physician workforce allows for the country to focus extensively on preventative medicine. The nation must take “immediate steps to address the issues that threaten primary care’s survival.” (ACP, 3) The ACA can only survive with the help of primary care physicians. The complaints of current primary care physicians must be taken into account so that the bill does everything possible to encourage growing number of primary care physicians.

    Many physicians that specialized feel that the huge payment gap between them and generalist doctors is fair because they perform several treatments which require more years of training to master. As discussed earlier, we have a “current fee-for-service payment system, which tends to reward tests and procedures over so-called ‘cognitive services’ such as patient consultations” (Harris, 1). Although primary care physicians perform fewer procedures, they spend much time counseling patients suffering from depression, dealing with social problems, and ensuring chronically ill patients’ treatments are effective. This time should be compensated because many studies are starting to realize the impact of primary care on the nation’s health. Duke University School of Medicine created a community partnership that treats patients in their own neighborhood (Harris, 1). This program has proved that improving and extending primary care to communities has led to “improved health outcomes while reducing costs by keeping patients out of emergency rooms” (Harris, 1) If primary care was implemented strongly across the nation, patients would prevent many diseases and our overall population would become much healthier. Hospitalization causes a large amount of money to be spent, especially when the patient is uninsured. With primary care being a focus of the ACA, many emergency hospitalizations costs will be prevented. The ACA should invest in primary care physicians and the quality they will bring to healthcare. Increasing payment to primary care doctors would compensate them for preventing expensive health care costs on taxpayer dollars. In the long run, focusing on primary care will lower health costs and increase the overall health of Americans.

    According to studies done by the Milbank Quaterly, “44,000 to 46,000 physicians are needed within the next fifteen years to meet future primary care demand.” (Hofer, 73)  The ACA needs to address workforce shortages that primary care is facing and devise provisions that target the problems that are contributing to these shortages. One way the bill is hoping to recruit primary care doctors is by increasing reimbursements with a “10% pay increase for their care of Medicare patients” (Bodenheimer, 2695). This will help students pay for their loans much easier if they choose to enter primary care residencies. Much of the money that is given to fund residency programs are used by the hospital and suggestions have been given that the “funding should be given directly to residency programs” (Bodenheimer, 2694). If the money would be given directly to the program, primary care residencies would have more control and provide more resources to train residents. Title VII, section 747 of the ACA recognizes the needs for primary care training and calls attention to creating more programs that provide more education and “funding to expand primary care capacity” (Goodson, 743) Expanding education and providing “need-based financial assistance for physicians in training and practicing primary care physicians” (Hofer, 82), will provide more resources and give more value to the role primary care will be playing in our near future.

    The ACA aims to make primary care a central focus for American healthcare. In order to make these changes, the number of primary care physicians must be increased. The primary care field must appeal more students and a change in attitude towards primary care must be elicited as well. The ACA has already begun to make changes. Out of a study “44% felt that the ACA was a good start” (Sommers, 1697), and 2011 marked the first increase in over a decade of physicians entering into primary care residencies. In fact, 2011 had the greatest increase in “family medicine, with a 21% increase (from 1071 residents in 2009 to 1301 residents in 2011)” (Sommers, 1698). Medical school applications have also increased, meaning that instead of discouraging students from going into the medical field, they are “responding positively to the ACA” (Sommers, 1697). Medical admissions must now give priority to “applicants with a strong underlying disposition towards primary care” (Hofer, 73).

     Medical scholars argue that simply funding primary care programs and even making more medical schools will not increase the number of primary care physician to specialist ratio. With all the funding given this will not directly make medical students choose to go into primary care. To fix this problem, “residency slots for specialist will have to be limited.” This is the only way to change the ratio and increase the number of primary care physicians before 2019, when the bill takes full effect. Opponents also say that increasing the facilities to provide primary care shadowing for medical students will also not increase interest because “students are more intrigued by “high technology procedures and training.” While this is true to an extent, the reason why many students are not interested in primary care is because they see primary care physicians overburdened by administrative paperwork and living off poor reimbursements for their hard work. With the ACA, primary care physicians will enjoy a payment increase and will be awarded according to their contributions to medicine. If the ACA does increase quality life for these physicians, they will be happier with their career and will inspire students to pursue a career in primary care. Not all medical students are into high tech medicine, many students go into medicine for the patients… for the strong human interactions they will have the privilege to engage in.

     As more students become excited about primary care under the ACA, more students will want to become part of a movement that is going to change healthcare in America. A stronger workforce in primary care will provide preventative care for millions of Americans and decrease health disparities across the nation. The attitudes of young Americans are positive about the future of primary care in America. With a strong focus on primary care, the lives of Americans will be changed. No longer should a person neglect their well-being and end up in an emergency room losing their life. Primary care will deal directly with all the major health problems America is known for: hypertension, obesity, Diabetes type II, and preventable emergency room visits. Primary care physicians under the ACA will become advocates for increasing health awareness in our nation, changing policies for the equality of health care for all, and saving our economy millions of dollars worth in health care costs. 

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