Primary health care is the cornerstone of non-emergency medical services, offering essential support to patients and promoting overall wellness. Even individuals in good health benefit from regular visits to their primary care physician (PCP) to sustain their well-being. However, the primary care sector faces numerous challenges today, ranging from increased patient demand to the complexities of modern health care needs. Addressing these challenges is essential to sustaining the effectiveness and accessibility of primary care services.
As the population grows, increasing patient numbers have become a common issue in health care today. According to the Physician Foundation’s 2018 survey, a primary care physician has to see 20 patients per day. However, in reality, this number can vary. If a physician serves a community for a long time and the surrounding people know them, these numbers will surely increase. The inverse also occurs with newly graduated physicians. In the same survey, the percentage of physicians identifying as private practice owners decreased to 31.4% in 2018 from 48.5% in 2012. Conversely, the percentage of physicians identifying as hospital or medical group employees rose to 49.1% in 2018 from 43.7% in 2012, with previous figures being 57.9% in 2016 and 52.8% in 2014. One of the main reasons is that newly graduated physicians are often unwilling to take on the extra hassle of owning private practice clinics. Another factor is the increasing number of retired physicians who own private practice clinics. Private practice clinics are crucial for serving rural and suburban communities where hospital services are seldom available.
Besides an inadequate doctor-to-patient ratio, issues like increasing walk-in facilities in clinics, improperly maintained appointment schedules, and a lack of patient education to differentiate non-emergency situations from hospital emergency visits also put pressure on primary care facilities.
As medical science advances daily, primary care clinics increasingly require newly updated lab and imaging facilities to keep pace with the latest developments. For example, basic modern imaging facilities, HbA1c detection devices, digital ophthalmoscopes, and digital respiratory function devices should be available in clinics, in addition to urine strip tests, pregnancy tests, EKGs, swab tests, etc.
In a study sponsored by the Centers for Disease Control and Prevention in 2011, physicians ordered lab tests on average for 31.4% of their patients per week. They reported uncertainty about ordering tests in 14.7% of cases and uncertainty in interpreting results in 8.3% of these diagnostic encounters. The most common problems they faced were lack of insurance coverage for the lab tests, complex and confusing result formats, and delays in receiving results or communication gaps between clinic and lab facilities.
In primary care, prescribing medication can be challenging due to inadequate insurance coverage. Sometimes, a lack of communication and understanding between physicians, pharmacies, and insurance agencies creates problems for both physicians and patients. In such cases, physicians may need to call or email a pharmacy or insurance agency, which causes delays in proper health management.
As primary care physicians, they must assess patients and complete a lot of paperwork, such as work exemption letters, disability forms, vaccination reports, referral letters, and sick notes. As private practice owners, it is essential to maintain the clinic’s basic standards and ensure that lab and imaging facilities are updated and re-registered at specified intervals.
Primary care physicians must respond to patients’ phone calls, messages, and emails, as this is essential for effective health care management and helps reduce communication gaps. Primary care facilities typically have established criteria for responding to emails and messages intended for non-emergency situations, and primary care physicians are required to reply within a specified number of business days.
A primary care physician also needs to update their licensing for controlled substance prescribing, human trafficking training, infection control, HIPAA certification, etc. Therefore, physicians need to be involved in many types of continuing medical education (CME).
These are some common challenges faced by primary care physicians today. Some of these challenges are integral to the practice itself, while others require thoughtful solutions to improve both patient care and the well-being of physicians. Addressing these challenges proactively can lead to a more sustainable and effective primary care environment.
Md Fazle Rabbi is an international medicine graduate.
