I'd like to make the case that generalists - be they internal medicine docs who see adults, pediatricians who see kids, or family physicians who do both, are best suited to address the health care needs of the majority of patients of all ages and in all geographic areas throughout the United States. In fact, we already know that health systems which emphasize generalist ("primary") care provide higher quality care at lower cost (1, 2). Other studies are finding evidence that obesity and related medical conditions decrease when there are enough generalists practicing in a community (3). Communities in which there is a higher proportion of generalists also benefit from:
- reduced all-cause mortality
- decreased emergency room and hospital utilization rates
- reduced medical waste from unnecessary testing and procedures
I believe that until we truly support incentives to increase the number of general practitioners, the health needs of our country will continue to go unmet - whether health insurance reform passes or not. I am not suggesting that we choose which areas of medicine students select as their specialty, or even that we require service in primary care of every trainee. What I am suggesting is that we need to recognize that the results of health care personnel shortages, increased need for doctors that practice in rural areas, and increased need for doctors who can care for the elderly and geriatric population, will place a heavy burden on our already crippled health system. We must decide how to address the issue creatively, so that we have an adequate supply of generalists who can treat chronic disease and work with their patients to prevent complications of those diseases. These are not conditions that can be easily fixed by a surgeon or a heart doctor working in a specialty group. We need generalists who can coordinate care for the elderly, who can work directly with social services and other members of the health care team, and who can devote a 15 minute visit to a discussion about quitting smoking or lifestyle changes to increase a persons level of activity. Otherwise, we risk becoming a population of overweight amputees on dialysis as a result of "poorly controlled" chronic disease.
(1) Macinko, J, et al. The Contribution of Primary Care Systems to Health Outcomes Within OECD Countries, 1970-1998. Health Serv Res 2003 June; (3):831-65.
(2) Starfield B, et al. Contributions of Primary Care to Health Systems and Health. The Millbank Quarterly, Vol 83 (3) 2005, 457-502.
(3)Gaglioti A, et al. Primary care's ecologic impact on obesity. Am Fam Physician. 79(6):446.
(4) Althouse, L and Stockman J. Pediatric workforse: a look at general pediatrics data from the American Board of Pediatrics. Journal of Pediatrics 2006, 148(2): 166-9.