Specialists’ Role in Easing Primary-care Physician Shortages

Recently there have been even more new studies reporting on the looming shortage of primary-care physicians and the growth of physician extenders to solve that problem. With those topics top of mind, I thought it was worth visiting the topic of specialists and their potential role in helping to address the challenges our healthcare system faces once again.

While specialists play a critical role in specific areas of patient health, they often find themselves also providing the majority of care to at least some of their patients, often those with chronic conditions that require monitoring and intervention.

Some argue that we shouldn’t use costly specialists to provide any kind of primary care to patients - extenders and other providers can offer that type of care to more people at a much lower cost.

Indeed it is this emphasis on controlling cost and expanding access that has led to the system we have now: primary care, increasingly provided by extenders, for routine and ongoing care, and specialists once a serious or chronic condition is identified. This is a straightforward system that works to an extent, but there is another perspective to consider. This issue must also be explored in terms of patients. What do they need? What do they want?

Clearly there are some illnesses that can be readily cared for by physician extenders. These skilled providers offer excellent care to many patients today. However, once a dominant chronic condition emerges like a coronary or an autoimmune disease, a medical specialist becomes integrally involved in virtually every aspect of a patient’s healthcare.

In the long run, such intensive care by highly skilled physicians may not cut costs. But isn’t the real issue quality and outcomes? Isn’t it better and easier for a patient to have that one single physician who is coordinating all of their care? Might it not be better for a "specialist" to take on an expanded role for patients with a specific condition, especially one that could be intertwined in some way with a routine illness?

I believe patients want this approach to care; they know it is important to their health and wellness. It is easier and often more comforting for them to have that single provider of care. Experience has shown me that these patients are willing to consider a concierge membership program with specialty physicians who are already providing much of their care.

For specialists considering concierge, I believe it is the hybrid option that can make this solution a viable reality. It can help ensure good specialists secure the reimbursement necessary to sustain their practice (and from a private revenue source), that they are incented to stay in practice caring for all their patients, and that they also continue to be able to practice in their specialty - a valuable expertise we can’t afford to lose.

This brings us back to the three most important questions we can ask when discussing this topic:

1. What is best for patients?;

2. What will keep good specialists in practice and their skills and knowledge sharp?; and

3. What system ensures better access to care for all patients?

For all three, I think the answer is a hybrid concierge approach that can carve out the ability to provide much of the basic care needed by chronically ill patients but within a specialist practice.

I understand there are still issues. Specialists are used to having extensive knowledge about their areas of expertise. The cardiologist asked to also provide care to their patient that has a GI issue may be uncomfortable with such a role. Yet, becoming proficient in other types of conditions, outside of the specialty, that may be presented is realistic. After all, most physicians already have a strong primary-care foundation either through initial training and education or because that is where they started their careers.

I am certainly not advocating that moving to a hybrid model works for all specialists. I am suggesting that those specialists who already recognize that caring for routine health needs is a key part of services they provide to some patients - and who are comfortable with that type of care - consider it as an option.

We need to explore a range of practice alternatives to keep healthcare working and ensure patients can access the care needed. I’d like to hear your thoughts about expanding the role of specialists in the space below.