Will the Ghost of Primary-Care Past Haunt Our Future?

As Maya Angelou said, “You can’t really know where you are going until you know where you have been.” I don’t think she was talking about primary care in the U.S., but she might as well have been.

Two new reports out this week attempt to quantify the past failings of primary care here and what medical care generally and primary care specifically could and should look like in the future. The Commonwealth Fund produced the first report, Primary Care in High-Income Countries: How the United States Compares, which you can download here.

Researchers from The Commonwealth Fund compared the performance of the primary-care system here with the performance of primary-care systems in 10 other high-income countries on 10 different measures. They used data from two international health policy surveys — one in 2019 and the other in 2020 — to make their comparisons.

The U.S. fell short on most of the performance measures. For example:

• The U.S. ranked last on the percentage of adults who have a longstanding relationship with a primary-care provider (43 percent)
• The U.S. ranked last on the percentage of adults who have access to home visits by a primary-care provider (37 percent)
• The U.S. ranked last on the percentage of adults who could see a primary-care provider after regular office hours (45 percent)
• And the U.S. ranked second to last on the percentage of adults who have a regular doctor or somewhere to go for primary care (89 percent)

Perhaps surprisingly, the U.S. did well on social determinants of health measures compared with other countries, although the percentage of primary-care providers doing the following is still pretty sad:

• The U.S. ranked first in the percentage of primary-care providers screening patients for social needs (30 percent)
• The U.S. ranked second on the percentage of primary-care providers that have social workers in their practices (37 percent)
• And the U.S. ranked second on the percentage of adults with regular doctors who received information on how to get help with their social needs (9 percent)

So much for the past. Now let’s talk about the future courtesy of the second report, Clinician of the Future, from Elsevier Health. You can download the 116-page report here. The report is based on a survey of nearly 3,000 doctors and nurses from 13 different countries or regions around the world, including the U.S.

Here’s what they said healthcare will look like in the future, which the researchers defined as 10 years from now:

• 82 percent said soft skills like listening and being empathetic by doctors and nurses will become increasingly more important
• 63 percent said the majority of consultations between clinicians and patients will be remote
• 62 percent said the relationship between clinicians and patients will be more of a partnership
• 56 percent said patients will be more empowered to manage their own medical conditions
• 49 percent said the majority of medical care will be provided in a patient’s home instead of a healthcare setting
• 45 percent said patients will be less likely to feel the need to see a doctor or nurse in person

The Elsevier Health report is rich with even more insights, but the bullets above tell you that, at least according to nearly 3,000 doctors and nurses here and abroad, the primary-care potholes identified in The Commonwealth Fund report, will be patched over thanks to healthcare consumerism, consumer-facing self-care, advances in medical and information technologies like remote patient monitoring and more enlightened medical education and training.

Doctors and nurses see the future. The question is whether the Healthcare Industrial Complex® and the current payment system let us get there.

Thanks for reading.