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Imbalance Between Primary Care and Speciality

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on 11 December 2014

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Transcript of Imbalance Between Primary Care and Speciality

Imbalance Between Primary Care and Specialty Care in U.S.
Amanda Ward
Ashton Rutledge
Lia Mccoy

Explaining the Imbalance Between Primary and Specialty Care

8) Why is there an imbalance between primary care and specialty care in the United States? What measures have been or can be employed to overcome problems related to physician mal- distribution and imbalance?
Objectives:
1) Introduction to topic (defn's)

2) Explanation of the imbalance between primary and specialty care

3) Consequences of the imbalance between primary and specialty care

4) Strategies to balance primary and specialty care

Primary vs. Specialty Care
Primary Care:
Basic or general health care traditionally provided by doctors trained in: family practice, pediatrics, and internal medicine.
Specialty Care:
Specialized health care provided by physicians whose training is focused primarily in a specific field, such as neurology, cardiology, rheumatology, dermatology, oncology, orthopaedics, ophthalmology, and other specialized fields.
Group Topic:
Advances in medical technology
Higher reimbursement and income for specialists relative to primary care physicians
Specializing is a more "attractive" option for medical students

Strategies
Expand National Health Services Corps
Increase pay for primary care providers
Target residency programs
Maximize the current primary care workforce
As the National Association of Governors
concluded in 2012, "Most studies showed that NP-provided care is comparable to physician -provided care on several process and outcome measures."
Sources:
http://www.cdc.gov/nchs/data/databriefs/db105.htm#Fig1
http://www.thepatientfirst.org/rescuing-primary-care-and-fixing-our-system.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295294/?page=1
http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6969
http://nhsc.hrsa.gov/scholarships/index.html
http://www.nejm.org/doi/full/10.1056/NEJMp0903460
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79
http://www.qwhatis.com/what-is-rbrvs/
http://www.hindawi.com/journals/scientifica/2012/432892
• There are many consequences that may occur to the imbalance of primary and specialty care
• By having too many specialist it may be the reason why specialist care has made an impact on the increasing amount of intensive, expensive, and invasive medical services, which is enhances the cost of healthcare.
• With surgery increasing drastically, the cost of the supplies for surgery is increasing the demand for initial contact with surgeons.
• There are many surgeries that are increasing and some may include coronary artery bypass, hip replacement, carotid, heart and liver transplant.
• Over the years these surgeries have become more common, and were hardly performed about fifty years ago.
• Today these surgeries are very common and the price of them are really expensive.

• The advancement of technology developments have also been the cause of healthcare costs.
• The US is known to have higher rates for coronary surgery, diagnostic imaging, neurosurgery, treatment for end-stage renal disease, and cancer chemotherapy than any other country.
• As some of these diseases and conditions are low, the access of specialists in our area can lead to performances of unnecessary procedures.
• In the United States, many patients associate the use of more advanced technology, more tests, and more procedures with better care – even if clinical evidence demonstrates that these additional treatments do not improve patient health outcomes.
• According to the Congressional Subcommittee on Oversight and Investigations there are about 2.4 million unnecessary operations performed nationwide.
• This led to the cost of $3.9 billion and 11,900 deaths.
• Overall primary care services are less costly than it is to have specialty services due to the fact that they are less technology intensive.

Consequences of the Imbalance:
• Technology developments include new drugs for treating ulcers, depression, and heart disease.
• These are new diagnostics based on genetic engineering, new imaging advances like magnetic resonance.
• The increase in computers to diagnostics and treatment, new endoscopic equipment and technique, and a breakthrough in the field of micro, minimal-incisions and laser assisted surgery.
• The cost that comes directly from specialist is often less effective, which is the opposite for primary care.
• Primary care facilities make a way for people to take care of their illness or problem before the illness becomes more severe.


• According to health affairs in 2007 the average payment to see a primary care provider for a follow-up it was $94 and in order for you to have a colonscopy performed by a gastroenterologist it was $203, and $670 for a cataract extraction done by an ophthalmologist, which only lasts about thirty minutes each.
• High level of primary care manpower is associated with lower overall mortality, and lower death rates due to disease of the heart and cancer, unfortunately specialty physicians cannot state the same, seeming as if they are positively and significantly are related to the higher mortality rate. In 2007, researchers reporting in the International Journal of Health Services found that an increase of just 1 primary care physician per population of 10,000 people resulted in a 5.3% reduction in mortality for the year 2000 (the year under analysis). On a national level, this would translate into 127,000 deaths potentially averted in that year alone.

• Primary care physicians have been major providers for those who are minority, poor and people who live in the undeserved areas such as those who live in rural towns and inner cities.
• The continual shortage of primary physicians could exacerbate access to care particularly for the underserved.
A recent analysis of state Medicare costs shows that increasing the number of general practitioners in a state by 1 in 10,000 population both increases the state's health care quality and reduces overall spending by $684 per beneficiary; therefore, increasing the number of primary care doctors would seem to be part of the magic elixir for lowering costs while raising quality of care that our country has been desperately searching for.
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