Contributing reporter: Patrick Verel
Changes in the U.S. healthcare system have created significant challenges in primary care, such as the management of chronic disease, improving the coordination of general care and meeting the increased demands that have arisen as a result of the Affordable Care Act.
So, what does the future hold?
Howard Zucker, LAW ’00, first deputy commissioner for the New York State Department of Health, said he believes it is time for primary care to shine during his keynote speech at “The Growing Importance of Primary Care: Are we ready for the Challenge?” The daylong conference, held by the Fordham Schools of Business in April, was organized and sponsored by the Global Healthcare Innovation Management Center’s EmblemHealth’s Value Initiative.
“This will end up creating an opportunity for everybody because it will be a chance to rebuild the primary care workforce so it’s bigger and better,” he said.
Just as advances in vaccines brought about a health revolution in the 20th century, he said, the nation is on the brink of another health revolution based on disease prevention. He touted New York’s “prevention agenda,” which seeks to prevent chronic diseases, promote a healthy and safe environment, provide access to mental health care and prevent sexually transmitted diseases.
“A primary care practice focused on prevention is truly the ultimate expression of the medical profession’s compassion and altruism, of how to improve the life of the patient,” he said.
The morning’s first panel, “Primary Care and the Affordable Care Act,” was moderated by center director Falguni Sen, Ph.D., and featured Linda V. Green, Ph.D., Armand G. Erpf Professor of the Modern Corporation at Columbia University; William A. Gillespie, M.D., president, AdvantageCare Physicians; Jaime Torres, M.D., regional director of the U.S. Department of Health and Human Services Region II; and Sumir Sahgal, M.D., medical director for Essen Medical Associates.
Torres talked about the Affordable Care Act’s effects on issues such as the expansion of Medicaid, as well as the $10 billion Innovation Center that’s testing new approaches around the country. Gillespie and Sahgal delved into the minute details of running a health system.
Green struck an optimistic tone, saying that her analysis has found that the predicted shortage of primary care physicians is overblown.
“When people talk about having too much of something or too few of something, I’m always curious as to how they reached that conclusion, particularly if there are differing conclusions,” she said.
When economists predict that a 51 percent increase in visits to primary care physicians in the next 20 years will only be accompanied by a 2 percent increase in the supply of doctors, they leave out the fact that between 2003 and 2012, the percentage of primary care physicians working as solo practitioners declined from 39 percent to 18 percent, she said.
“The era of the solo practitioners or a small medical practice is . . . going to be entirely dead in a few years. Now we’re in the era of larger practices—and that alone makes a big difference,” she said.
Green said her research showed that when a doctor is part of a team of three that utilizes technology for “e-visits” and other health workers such as therapists and nutritionists, the number of patients they can see on a same-day basis increases 46 percent.
“We have examples of health care systems all over the place that are doing this,” she said. “It’s not just theory.”