My first physician was Dr. Asa Graves V of Lacey Spring. As my mother’s physician, Dr. Graves delivered me more than a few years ago. He practiced as a general practitioner (GP), and I admired his skill so much that I clearly remember once answering a question for a school exercise with: “I want to be a GP when I grow up.” He practiced for 50 years and seemingly took care of just about everything. Even if a prescription was needed, he usually was able to dispense it from his own pharmacy. He had a real “doctor’s black bag” in his office, which was attached to his house. He saw the patients in his waiting room on a first-come, first-served basis, with no appointments, and he would keep taking care of patients on any given day until everyone had been seen—no matter the hour. The office decor was modest, the staff (Mrs. Graves) was friendly, and the medical record was, well, succinct. His patients—my mother included—loved him and the care he provided.
Fast forward about a half-century to the health care of today’s world. Medical knowledge has expanded exponentially, and many types of providers are now available to promote health and treat disease. Still at the heart of health care, however, is the modern-day GP, also known as the primary care provider, or PCP.
Vital to Patient Care
For many patients, family physicians, internal medicine physicians, pediatricians, nurse practitioners and physician assistants are their first contact with the healthcare system. These caregivers offer preventive screenings and services like flu shots, cancer screenings and health counseling. They also diagnose and treat a wide range of common illnesses, spot small problems before they become big problems, and manage numerous chronic medical conditions. Dealing with such a broad range of knowledge, PCPs fill many roles, serving as medical experts, scholars, communicators, professional collaborators, managers and health advocates—in short, they are indispensable to our healthcare system.
PCPs help us stay out of the hospital, live longer, feel better, and avoid disability and long absences from work. We know this because the available evidence demonstrates that people who do not have regular access to PCPs are in the emergency room more often and are admitted to the hospital more frequently. In places with better access to primary care, death rates for cancer, stroke and heart disease are lower, and hospital visits less common.
PCPs juggle the needs of patients from different stages of life. People from my parents’ age group are sometimes called traditionalists. They have more chronic disease management needs and value that continuing connection with one or a select few providers. They also value service, and being able to obtain testing and other healthcare needs at the same office is a big plus for them.
My generation, the baby boomers, is sometimes called the “most spoiled” generation: We have health needs, but sometimes we don’t want to admit it! We value convenience in our primary care experience above most everything else.
Members of Generation X, as well as Millennials, are very different in their healthcare wants. They value extended hours and short waits, often because their health needs are not chronic. They want great care, but they don’t want to deal with the inconvenience of appointments and waits. Some research even demonstrates that this group would rather have much of their care delivered by a smartphone app than by a PCP.
In today’s healthcare environment, PCPs must be able to deal successfully with a wide range of expectations arising from these generational differences.
Addressing the Challenges of Modern Primary Care
The benefits of primary care are clear, but there are clouds on the horizon. Gaining access to primary care is a growing concern. Nationally, an imbalance exists between demand for care and capacity for care. Demand is growing as the population expands, ages, and faces chronic diseases like diabetes, heart failure and obesity. Meanwhile, capacity is shrinking as the proportion of PCPs drops, relative to the increasing demand. At the individual provider level, it is estimated that PCPs would need to work an average of 18 hours a day to provide adequate coverage for all those in the healthcare system who require chronic and preventive care.
Some experts argue that this capacity problem is actually a distribution problem, with fewer providers now located in more rural areas. Others, however, feel the problem is rooted in the decreasing number of providers who choose to practice in the primary care specialties. Regardless, it would take a dramatic increase in the proportion of U.S. medical students who choose primary care careers to reverse this trend, and decades to rebalance capacity with demand. Clearly, this is not a sustainable path.
To address these concerns, we at the Sentara RMH Medical Group (SRMG) are redoubling our efforts to provide our patients with access to care—in fact, this is one of our practicewide goals for 2017. Providing primary care as a team, increasing the number of team members, increasing efficiencies of the team and having multiple avenues of access to that team are a few of the strategies we are employing to help bridge this looming access gap.
The patient-centered medical homes at our East Rockingham and South Main locations are good examples. The medical home is not so much a brick-and-mortar structure as it is a care paradigm that involves a wide variety of clinical and nonclinical team members who provide counseling, care management and navigation, follow-up contact after hospitalization, prescription monitoring, and coordination with other healthcare professionals. This paradigm helps to serve a greater number of patients in a more efficient and effective manner, thereby improving overall access to primary care.
Most of our practices involve both physicians and advanced practice providers—nurse practitioners and physician assistants—who work together to provide increased access to care in the communities they serve. As well, SRMG has implemented a practicewide electronic health record to link all of our practices together, providing a platform for exchanging important health information among providers, helping to improve quality of care. In addition, SRMG has opened a new primary care practice on East Market Street in Harrisonburg and recruiting more primary care providers for other locations. We’re also involved in a collaboration between SRMG and Carilion Clinic to open the new Bridgewater Health Center later in 2017. And the future will bring new avenues of access we have not yet even considered.
We have more tools now to utilize in caring for our patients, but the challenge is still the same as it was for Dr. Graves more than a half-century ago: providing access to high-quality health care for the residents of the Shenandoah Valley. It’s an exciting time to be in medicine, and everyone at SRMG is committed to providing access to the finest care in our region.