{"id":31402,"date":"2014-04-22T10:00:20","date_gmt":"2014-04-22T09:00:20","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=31402"},"modified":"2015-09-22T14:35:34","modified_gmt":"2015-09-22T13:35:34","slug":"william-cayley-is-primary-care-in-the-us-really-the-future","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2014\/04\/22\/william-cayley-is-primary-care-in-the-us-really-the-future\/","title":{"rendered":"William Cayley: Is primary care in the US really the future?"},"content":{"rendered":"

\"bill_cayley\"<\/a>Is primary care really the future? I\u2019d like to say \u201cYes,\u201d but I\u2019m not so sure\u2026 (at least in the USA).<\/p>\n

There has been much talk and writing about the growing need for primary care physicians to serve our population, and one \u201cpromise\u201d of the Affordable Care Act is \u201cits potential to make primary care more accessible<\/a>.” At the same time, the major family medicine organizations in the USA have embarked on an ambitious project to \u201cexamine the challenges and opportunities facing family medicine today, and define a path forward in the context of a rapidly changing healthcare landscape.<\/a>\u201d<\/p>\n

All of this should be reassuring, especially in light of Starfield\u2019s oft-cited demonstration that \u201cprimary care helps prevent illness and death,<\/a>\u201d but I\u2019m not sure what sort of growth in primary care we are actually seeing. A report released last week by the IMS Institute for Healthcare Informatics found that in the USA in 2013 \u201cprimary care visits continued to decline for the fourth consecutive year,<\/a>\u201d while specialist visits increased by 4.9%. At the same time, the hospitalist movement continues to grow in the USA<\/a>, despite the fact that hospitalist care may lead to higher medical utilization and costs after discharge<\/a>, and health economics research continues to explore (among other things) how primary care can provide \u201cdownstream revenue\u201d to specialty physicians and services.<\/p>\n

Are we really seeing the growth of primary care, that is, the development and support of a solid and well-trained primary care workforce, empowered and encouraged to provide the breadth, depth, and continuity of care that can improve our patients\u2019 lives?<\/p>\n

Or are we seeing the growth of a system that views primary care as a pipeline to feed specialty services, or a source of patient referrals to bolster income?<\/p>\n

I\u2019m a family doc and I love what I do\u2014and while I hope for the first vision to become reality, I\u2019m becoming increasingly concerned we are actually seeing the development of the latter.<\/p>\n

Competing interests: \u201cI declare that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare\u2014I\u2019m just a family doc!”<\/em><\/p>\n

William E Cayley Jr<\/strong> practises at the Augusta Family Medicine Clinic, teaches at the Eau Claire Family Medicine Residency, and is a professor at the University of Wisconsin, Department of Family Medicine. <\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Is primary care really the future? I\u2019d like to say \u201cYes,\u201d but I\u2019m not so sure\u2026 (at least in the USA). There has been much talk and writing about the growing need for primary care physicians to serve our population, and one \u201cpromise\u201d of the Affordable Care Act is \u201cits potential to make primary care […]<\/p>\n

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