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More Primary Care Docs in a Community Equals Healthier Seniors

By Amanda Gardner
HealthDay Reporter

TUESDAY, May 24 (HealthDay News) -- The more primary care doctors a community has, especially ones who are actually practicing primary care, the healthier seniors in that community are, a new Dartmouth study suggests.

Those communities see fewer preventable hospitalizations and a slightly lower death rate among local elders, the researchers found.

"This reinforces something the American Academy of Family Physicians [AAFP] has stood on for a long time: that a well-trained physician can maintain outcomes," said AAFP president Dr. Roland Goertz, who noted that some 100 different studies have now come to the same or similar conclusions.

This study and others come in the context of a shrinking pool of primary care doctors. A study last month found that the percentage of medical students who want to go into primary-care medicine has dropped sharply over the past two decades, from 57 percent in 1990 to 33 percent two decades later.

In 1990, 57 percent wanted to go into primary-care medicine vs. 33 percent in 2007, according to that earlier study. Those choosing to practice general internal medicine in 2007 fell from 9 percent to 2 percent. And in 2008, only 264 U.S. medical students chose residency training in primary care internal medicine, compared to 575 in 1999.

Yet, having more primary care doctors is a cornerstone of most strategies to improve health-care quality and lower costs in the United States, the authors of the current study report. Their finding appears in the May 25 issue of the Journal of the American Medical Association.

These authors looked at physician claims for about 5 million Medicare beneficiaries aged 65 and older culled from American Medical Association files. The claims including specialty coding for the physicians and the type of care provided, said study author Chiang-Hua Chang, a research instructor with the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.

Seniors in areas with the highest number of primary care doctors had fewer preventable hospitalizations and fewer deaths.

The differences were admittedly small. For example, the Medicare enrollees living in areas with the most primary care physicians per capita had a 6 percent lower rate of preventable hospitalizations.

But the authors also found that it is not enough just to be trained in primary care. Doctors have to be practicing primary care as well, something that future studies need to take into account, Chang said.

Many doctors trained in primary care seem to be practicing in specialties such as emergency medicine or inpatient care only, she added.

"I think this raises several important questions," said Dr. Lawrence C. Kleinman, an associate professor of health evidence and policy at the Mount Sinai School of Medicine in New York City. "We need to be making sure that there are adequate primary care physicians and adequate distribution of those physicians."

"Right now, we tend to pay when doctors do things but we don't tend to value when doctors prevent things, which means manpower is shifting from primary care to specialty care," he added.

Is the shortage going to let up?

"Not in the way we currently organize and finance care," Kleinman said. "Medical students respond to their value and their market forces, and currently the amount of debt and reimbursement discrepancies are trumping people's values and other preferences."

More information

The Health Resources and Services Administration has more on primary health care.

SOURCES: Chiang-Hua Chang, Ph.D., research instructor, Center for Health Policy Research, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H.; Roland Goertz, M.D., president, American Academy of Family Physicians; Lawrence C. Kleinman, M.D., associate professor, health evidence and policy and pediatrics, Mount Sinai School of Medicine, New York City; May 25, 2011, Journal of the American Medical Association

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