A response to “A call to arms: Connecticut needs more primary care. The time is now to change the course of medicine in our state.”
The column by H.Andrew Selinger MD is a good introduction to the primary care problem here in Connecticut. As chairman of the Department of Family Medicine at Quinnipiac University, he has done a good thing by bringing this to the public arena.
I have been in general practice in Bethel for over 40 years. Here are some reasons and solutions to the primary care problem as I see them:
First. In most of our community hospitals primary care has been allowed to wander without direction like a lost child in a crowd. Most hospitals have no departments of primary care, no administrators that speak for primary care, no primary care leadership. It has little prestige compared to the specialties.
It is hard to understand why primary care has been neglected because ever since the Millis Commission report in 1966, policymakers have been warning about the need for training more primary care doctors, but most medical schools (unlike Quinnipiac) continued to focus on training specialists.
Lacking leadership and representation in our hospitals the needs of primary care were and continue to be subordinated to those of the specialties.
Second. The field of primary care has changed radically. Insurance companies’ restrictions have forced primary care doctors to see too many patients in order to make a decent living. They’re spending too little time with them and spending too much time with paperwork and putting information into computers.
Primary care physicians are overworked and dissatisfied —many are burned out and I don’t know of any that have recommended a career in primary care to their children or anyone else.
Under these conditions is it surprising that medical students do not choose primary care as a career?
Third. It takes about 11 years to train a primary care doctor. This could be reduced if the training were made more practical. Most no longer see hospital or nursing home patients and many limit what they do in the office for fears of malpractice suits. But medical schools are still specialty-oriented and I doubt they will change.
So it is likely that well-trained nurse practitioners will be joining the primary care workforce. They can treat many of the problems that occur in a typical primary care practice. This is a role that the National Academy of Medicine supports. Already, Connecticut is one of 22 states that along with the District of Columbia has given them licenses to practice independently. Connecticut is one of the states where nurse practitioners are independently licensed.
I agree with Joy Elwell APRN. She is right to say that nurse practitioners can help take care of Connecticut’s primary care needs.
I don’t see nurse practitioners as competing with doctors. I see them as partners in transforming the primary care workforce.
It is still a work in progress. If done right Connecticut will have taken a giant step forward in making primary care more available to its residents.
Edward Volpintesta MD lives in Bethel.
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