Seeing firsthand the ways in which primary care and the health care system in general don't work for many of the neediest patients, this med student urges Minnesota legislators to support innovative models of care that will serve patients better and attract more students.
By Peter Meyers
Mary went to the emergency room 68 times in 2013 despite the fact that she didn’t have 68 emergencies. She was also hospitalized four times for causes that mostly could have been prevented. She suffers from chronic pain, insulin-dependent diabetes, depression, and PTSD. Mary is 34 years old and has health insurance, but the system clearly isn’t working for her.
As a medical student interested in primary care, I’ve met a few people like Mary. Mary is suffering from multiple chronic diseases and several social barriers to obtaining proper health care. The heartbreaking reality is that patients like Mary, and there are frighteningly many, do not fit into the traditional paradigm of clinical care in the US.
According to the Agency for Healthcare Research and Quality, one percent of the population accounted for 22 percent of total health care spending in 2008. In Minnesota, this would represent roughly 53,000 individuals accounting for $5.7B in health care expenditures in 2013
(or about $107,000/patient/year).
People like Mary shine a light on the shortage of primary care physicians and the dysfunction of our current system. Mary and her physician require time together to build their relationship and determine the best plan for Mary’s health. But because of her multiple chronic conditions, Mary also needs more convenient transportation, a care coordinator, a social worker, a mental health team, and health educators. As baby boomers age, and the ACA expands coverage, others will need the same services. As a result, we will all start to feel the impact of this shortage immediately.
In its current state, our primary care system is not only dysfunctional for patients but also unappealing for most medical students trying to decide on a specialty.
A 2010 national report
recommended at least 40 percent of graduating medical students enter primary care in order to alleviate our provider shortage. Unfortunately, the rate of students entering primary care has been stuck at a shocking 12 percent for the last five years
. Students considering primary care are concerned about infuriatingly short visits with patients, burdensome paperwork and insurance regulations, payment systems that heavily favor specialists, and extremely high rates of burnout for primary care physicians
A current and central strategy to alleviate this shortage has been to incentivize primary care training programs with targeted student loan forgiveness. While commendable, this strategy essentially amounts to more hands bailing water from the sinking Titanic.
If we want to address this workforce shortage, we need to redesign the entire delivery system, which includes the insurance companies, employer groups, providers, and agencies that work together to provide health care.
We have the best-trained health care workforce in the world, but many Minnesotans experience a third-world delivery system. Those Minnesotans pay for their medical care out-of-pocket or they refuse to see a provider because it is unaffordable. The basics for real reform must include
an aggressive dedication to preventive medicine and patient empowerment, affordable access for patients, team-based coordination, community engagement, and, perhaps most importantly, more time for provider-patient visits.
I want to be a primary care doctor in Minnesota. My family is here, my wife’s family is here, and we’re excited about a future in Minnesota. But my current career landscape includes a mountain of debt and a future of stress associated with cramming an endless number of short patient visits to keep up with insurance company regulations.
Currently, primary care resembles an assembly line, a model that grossly underutilizes the training of health care professionals. This results in dissatisfaction and burnout or resentment towards coworkers and patients. I don’t want to be associated with a field like that. I want to be able to talk to patients for longer than ten minutes; work in a team-based environment that prioritizes preventive medicine; offer my skills to help improve people’s health; and connect with my community to contribute to a healthy neighborhood and society. Studies have shown that patients of satisfied doctors are more likely to adhere to treatment protocols, while dissatisfied physicians report more difficulty caring for patients.
In order to make a transformative contribution, I support pending legislation to create a Minnesota Legislative Health Care Workforce Commission (H.F. 3222) and urge its potential members to study models of care around the country that prioritize comprehensive, team-based medicine where patients are truly the center.
Two examples of successful care models currently operating in the US are the Nuka model for care in Alaska
and the CareMore project in California
. The commission should consider incentivizing pilot projects in Minnesota that emulate these transformative practices.
If you design a delivery system that gives providers enough time with patients and the incentive to do their job well, more students will choose primary care and there will no longer be a shortage.
Peter Meyers is a medical student at University of Minnesota. His op-ed appeared first in the MinnPost