This contradiction is at the heart of a new study by Dartmouth Medical School's Chiang-Hua Chang and colleagues published this spring in the Journal of the American Medical Association. The study of Medicare beneficiaries adds to a growing body of evidence that finds access to primary care doctors such as internists and family practitioners improves health.
Studying the 2007 medical records and hospital claims of more than 5 million Medicare patients, the researchers found that older people living in areas with the greatest access to full-time primary care doctors practicing in offices or outpatient clinics were 9 percent less likely to be admitted to a hospital for preventable conditions — and their death rates were about 5 percent lower than those in areas with fewer primary care doctors.
But Medicare spending was 1 percent higher in the areas with more primary care physicians — $8,857 per beneficiary compared with $8,769.
Primary care doctors are expected to be critical players in expanding coverage to 32 million uninsured Americans by 2014 under the Affordable Care Act. But with fewer U.S. medical school graduates choosing to practice primary care, and more opting for more lucrative medical specialties, the American Academy of Family Physicians now predicts a shortage of 40,000 primary care doctors by 2020.
"Primary care physicians are very important to quality, cost-effective care that includes coordination and continuity of care," says Alain C. Enthoven, a Stanford University health care scholar.
"The U.S. has one of the lowest primary-care-to-specialty ratios among the developed countries," says Robert Berenson, M.D., a health policy expert with the Urban Institute in Washington, D.C., and a former practicing internist.
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Loren Stein is a freelance writer who lives in Washington, D.C.