However, one important way to assist address the state’s provider deficit is to recruit current physicians who are undergoing training.
Having worked as a primary care internal medicine practitioner in Westbrook, greater Portland, for over 35 years, I feel obligated to respond to Dr. Alvarez’s Dec. 30 Press Herald op-ed on the provision of basic medical care.
Timely access to primary care is a challenge for both patients and doctors. Since many of these patients require additional lab or X-ray examinations, most primary care offices lack the necessary tools and expertise to handle acute issues. As a result, the majority of these patients are directed to urgent care facilities or emergency rooms, possibly with good reason. The inability to schedule routine care is a greater worry.
I’m a citizen patient customer now that I’m retired. I noticed a clash with my PCP appointment last April. She gave me an appointment for January 2025 when I called the office. Instead, I decided to schedule an appointment with her office nurse practitioner, which was successful. I understand that some patients might be upset about seeing someone other than their doctor, but NPs and PAs can be crucial to improving a primary care office’s accessibility, competence, and convenience. In my experience, they are capable, accountable, and perceptive.
The author raises an important point regarding physician burnout, which is a growing issue in both primary care and specialty medicine across the country. According to the author’s personal experience, this is an issue. Being a doctor is difficult, both mentally and emotionally. Maintaining a full workplace schedule that demands quick decisions and giving every scenario the consideration it need is challenging.
With varied degrees of success, doctors attempt to address this by fitting administrative work, medical education, leisure, vacation, and other interests into their schedules; nevertheless, this further reduces the amount of time they can spend with patients. Once more, having NPs and PAs on staff can help patients receive the lengthier conversations, improved communication, and medical education they need.
The idea of “direct primary care” as a practice model is one that I disagree with. Although the title is very appealing at first glance, it appears to be a new name for “concierge medicine.” Ironically, despite voicing concerns about the expense of healthcare, the author suggests a system that would require people to pay membership fees in order to continue being active patients in their primary care clinics. No medical services are provided in connection with these costs.
According to national surveys and historical data from our own multi-site internal medicine practice, there are typically 1,400 active patients (defined as those seen in the last two years) per physician, compared to 1,600+ prior to the introduction of electronic medical records. The aforementioned “direct primary care” or “concierge medicine” practice models would necessitate a reduction in these patient panels in order to accommodate lengthier office visits, etc. That number can occasionally be as low as 600, which is a frequently used fictitious number per physician. Many people would not have access to primary care as a result of this shift to seeing substantially fewer patients. I’ve witnessed this occur. Will a patient’s capacity to pay for membership or the selection of simpler, healthier patients influence their choice?
Overall, it appears that there is a mismatch between supply and demand. Maine’s aging and expanding population undoubtedly necessitates more services for preventive care as well as for all other facets of acute and long-term healthcare. As an excellent example of attempting to balance supply with the constantly rising demand and need for services, I must mention one program in Maine that addresses this: the Tufts Maine Track Program, which uses the partnership between Maine Medical Center and Tufts University School of Medicine to encourage more Maine students to pursue careers in primary care medicine.
My findings are as follows: 1) There is a clear issue with primary care access and supply.
2) Primary care offices and other healthcare facilities must use physician assistants and nurse practitioners.
3) No practice model aimed at enhancing treatment for the entire community is focused on reducing the number of patients seen.
4) In light of the long-term issue, efforts to expand the finite number of primary care physicians are the only viable solution. To care for our aging population, more aspiring doctors need to be persuaded to pursue careers in primary care.
