The Post–COVID-19 Case for Primary Care
Much has been written and discussed about challenges faced by the US health care system, with most of it justifiably concerning the payment system for medical services, and how that leaves an unconscionably large proportion of US residents uninsured or underinsured for quality care. Although payment systems are undoubtedly a challenge and merit substantial conversation, the structure of US health care delivery also leaves much to be desired.
Central to that problem is the paucity of primary care physicians in the US. The approximately 200 000 active primary care physicians in the US represent about 30% of all active physicians, down from 32% about 10 years ago. About 28% of men and 17% of women report they do not have a primary care physician. The Council on Graduate Medical Education recommended an increase in the proportion of primary care physicians to 40%, a recommendation now further from reality than it was in 2010 when the report was published. By way of comparison, about 50% of Canadian physicians are primary care physicians. As a result, a substantially smaller proportion of persons in the Canadian population—about 17% of men and 12% of women—report not having regular access to a physician.
The shortage of primary care physicians is not a new concern, and has been on the minds of policy makers for decades.1 But the issue has never quite risen to the level of policy attention that would command serious action, despite concerns about impending workforce shortages that could make the problem even worse.2 The COVID-19 pandemic may present an opportunity to elevate the role of primary care in the US anew, reaffirming the centrality of primary care in the practice of medicine, and in so doing reinvigorating efforts to achieve the right number of primary care physicians in the country. Three arguments make the case robustly for primary care: the importance of having a primary care infrastructure in place before a crisis to deliver care where and when it is needed; the need to build trust in health care systems; and the importance of delivering care to populations within their local context and lived realities.
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