The Nine Forces Converging On Primary Care: #1 The Affordable Care Act

In the last blog we looked at the Perfect Storm and its metaphoric counterpart, the forces that loom on the near horizon and threaten the current viability and future hope of primary care medicine. The first is the Patient Protection and Affordable Care Act usually shortened to “the ACA” and more commonly called, by opponents and supporters alike, Obamacare. The ACA hasn’t created the primary care crisis in America, but it will reveal the fractures in the current system and contribute to the pressures already directed to the PCP unless it can effectively re-engineer how we care for patients in the exam room.

We’re still in a short holding pattern on exactly what to expect, but we do know that large numbers of newly insured people, estimates range to 30 million plus, will be presenting themselves to primary care doctors. As waiting rooms fill up, many doctors will not be in a position to accept new patients.  As I discussed in The Familiar Physician: Saving Your Doctor in the Era of Obamacare, the Massachusetts experience, probably the closest model we have for comparison, doesn’t offer a lot of hope in that area.

My colleague, Paul Grundy, MD is frank about the broken payment system in America and its affect on the people it’s meant to serve. “The rewards system in health care is so convoluted that people become opportunities to make money. Somewhere in all that we lose the humanity.”

Regardless of your stand on reform (and I still find myself on both sides of specific ACA provisions) the fact is that the United States Supreme Court upheld the constitutionality of most of the reform legislation.  So if you’re waiting on the health train, that one has left the station.

Based on discussions with colleagues I am not alone in my contention that the success of reform and its role in improved health care delivery depend on a robust and expanding primary care workforce. I believe further that reform will be at its most effective if it helps strengthen the doctor-patient relationship as a powerful, quality-producing, cost effective force in medicine. In the meantime I ask people to “imagine health care without the Familiar Physician. “Every time you’re sick, you’re a stranger, enduring long waits for someone to help solve your problem … someone who may have never seen you before.”

Between 2010 and 2011, the number of insured Americans grew by just 3.6 million people, an increase of less than 1.5 percent that was easy to absorb into the existing system.  However, the instantaneous 15-percent increase in the number of insured Americans will shock a system accustomed to much slower growth. The potential for serious gridlock is clear.

So here’s what we’re left with: the ACA, which can be a positive force in improving access to coverage and, ultimately, to care, also carries within it the potential to crush the primary care system unless we make appropriate changes … and quickly.