Primary care is crucial for improving health outcomes and lowering overall healthcare costs.

A 2021 National Academies of Sciences, Engineering, and Medicine report states, “People in countries and health systems with high-quality primary care enjoy better health outcomes and more health equity.”

Investing in primary care also reduces overall healthcare costs. As the Purchaser Business Group on Health (PBGH) reported in 2021:

Evidence shows that improved primary care translates into healthier, happier patients and lower overall healthcare costs:

The problem, however, is a growing shortage of primary care physicians (PCPs). The COVID-19 pandemic only accelerated a disturbing trend: more and more PCPs are burned out from the need to see large numbers of patients and growing administrative burdens. They are either retiring or transitioning to “concierge” practices, which reduces the size of their patient panels.

In addition, fewer medical students are going into primary care because other specialties are more lucrative at a time when medical school debt is mounting. The result of the combination of these factors, according to the Association of American Medical Colleges (AAMC), is that the U.S. is expected to face a shortage of 21,000 to 55,000 PCPs by 2033.

While offering family medicine at the same conveniently located clinics where urgent care and occupational health services are offered improves access, it does not directly address the primary care physician shortage.

In order to do this, the primary care services offered in our clinics – which we refer to as family medicine to distinguish it from the treatment of patients who have serious comorbidities that need more specialized attention than we are set up to provide – are mostly provided by Advanced Practice Providers (APPs) rather than physicians.

These are masters-prepared nurse practitioners and physician assistants who enter into collaborative practice agreements with local physicians who delegate their prescriptive authority to our APPs and are available to them for consultations but who do not have to be on-site at our clinics.

Research has consistently shown that APPs are able to provide care that is comparable in quality to that of physicians within the limited scope of most primary care practices. It is essential to patients and our healthcare system as a whole that APPs (and all other healthcare workers) be allowed to practice at the top of their medical licenses.

The third component of our strategy to increase access to primary care services is providing care virtually when appropriate. The basic concept is that we will treat patients virtually if we can, and if not, we will refer them to a nearby clinic.

Obviously, not all medical conditions can be treated virtually. However, the number that can be is expanding all the time, and virtual visits can be particularly effective in follow-up care. In general, offering virtual care expands access – particularly in underserved areas – provides convenience to patients, reduces costs, and increases clinician productivity if they are able to see patients virtually when they are not seeing them in person.

Increasing access to primary care in the face of a growing primary care physician shortage is a significant challenge. Still, it is crucial in improving health outcomes and equity and reducing costs.

At FastMed, we are, by no means, declaring victory in meeting this challenge. We have been able to begin making a dent in it by offering family medicine in some of our urgent care clinics, using APPs rather than physicians to provide the care, and treating patients virtually whenever possible.

Stay tuned for my next blog, which will discuss the role of “value-based care” in supporting primary care practices and aligning incentives so that the care being provided is driven by patients’ outcomes rather than the number of patient visits, tests, and procedures.