Health Matters: The power of primary care: Having a primary care physician leads to better outcomes

You might think that if you had a cardiologist for your heart, a neurologist for your brain, a podiatrist for your feet and so on that you would have excellent health care. The data tells a different story: Having a primary care physician who specializes in you (as opposed to having multiple physicians who each specialize in different organs and diseases) leads to better outcomes. This phenomenon is called the “primary care paradox,” and is demonstrated on the local, county, state and national level in many studies:

Local: Adding just one primary care provider for 10,000 people translates into 4.9 fewer deaths each year. Patients who see a single provider are more successful in quitting smoking and are more likely to receive flu shots. Communities that have more primary care physicians have lower rates of hospitalization for diabetes complications, pneumonia, and hypertension. People who use a consistent health care provider for most of their health care needs are more satisfied, more likely to comply with physician instructions and are less likely to end up in the hospital or emergency room.

County: Counties with more primary care physicians per capita have lower rates of obesity, now the second leading cause of preventable death in the U.S. These counties also have improved health outcomes in the following areas:

lower risk of death in general

lower risk of death due to cancer, heart disease or stroke

lower infant mortality

lower rates of low-birth-weight newborns

longer life expectancy

better self-rated health

State: States with more primary care physicians per capita have lower per-patient Medicare expenses, and higher performance measure scores. These states also have lower stroke mortality, infant mortality and all-cause mortality, as well as fewer low-weight births. Dr. Barbara Starfield, University Distinguished Professor in the Johns Hopkins School of Public Health, notes, “From a population viewpoint, there is considerable evidence for the benefits (on health outcomes) of an increase in supply of primary care physicians, and no evidence for a similar effect for specialists.”

National: A Medical Outcomes Study showed that functional health status outcomes in patients with chronic disease (such as diabetes) are similar whether the care was provided by specialists or generalists, but that generalists used fewer resources (creating fewer costs) to achieve the same quality. Dr. Robert L. Phillips, Jr., Director of the Robert Graham Center, summarized the data: “Primary care clinicians use fewer tests, spend less money and protect people from overtreatment more than do the subspecialists from whom people seek routine care.” For poor or uninsured Americans, access to primary care is especially important — it is associated with improved clinical outcomes, more complete immunization, better blood pressure control, better dental health, increased lifespan and improved quality of life.

The evidence shows that primary care medicine is associated with significant improvements in the prevention, diagnosis and treatment of disease, as well as increased lifespan and improved quality of life. However, 19 percent of Americans have inadequate access to primary care and 13 of 56 Montana counties lack family physicians. We are facing an impending primary care supply crisis.

Programs like those at RiverStone Health, including WWAMI and the Montana Family Medicine Residency, are already providing evidence-based training with a high retention of primary care physicians in Montana.

However, Montana has fallen to the bottom of the nation in the support it provides to undergraduate and graduate medical education.

If our legislators want to secure quality health care for their constituents, their families and themselves, the way to do this is clear. They will need to move away from threatening to cut health professions pipeline programs any further and increase the support for these programs to at least the national average level. Montanans deserve a quality primary care system.

Michael Geurin, M.D., is director of Research and Scholarly Activity with the Montana Family Medicine Residency, and lead physician at RiverStone Health's rural clinic in Worden. He can be reached at 406-247-3318 or mike.geu@riverstonehealth.org.