by Dr. Nina Birnbaum, regional medical director, Blue Shield of California
The value of primary care is hard to argue against. At its core, primary care is about getting to know patients — their health, their family history, the socio-economic factors impacting their lives — and maintaining those relationships over time so that physicians and other clinicians can deliver the best care at any stage of their lives.
Whether a physician, nurse practitioner or physician's assistant, primary care clinicians conduct preventive routine exams, treat health conditions, diagnose chronic disease, support end-of-life care, assess patients’ mental health and how it interplays with their physical health, and so much more. We provide multifaceted, long-term care that requires us to truly know and understand our patients as people, not just patients.
Yet, one in three people don't see a primary care clinician.
They may opt for an urgent care visit if they’re unsure what to do about a health concern. They might think feelings of sadness and depression are irrelevant to primary care clinicians. They may head to the ER if they believe it’s a time-sensitive issue.
The reasons patients aren’t seeing primary care clinicians feel personal, but it comes down to one thing: people haven't yet experienced the value of primary care or are unaware that having one person serving as their central hub can make a significant difference for their health and how they receive care.
It’s time we fix that.
A central hub for care: How it works
As primary care clinicians, we serve as the connective tissue across our patients’ overall health journey, which has positive implications for all the concerns, conditions and types of care they will come across in their lifetime.
We coordinate with our patients’ specialists, whose job it is to know diseases deeply and understand the best course of treatment rather than know the individual person well. We discuss and share important notes with other clinicians, ensuring everyone involved in our patient’s care is informed of updates or progress from other visits. Our responsibility as primary care clinicians is to piece everything together and keep track of the whole picture.
Say a patient is 10 days out from a cold, has a fever and starts having pain on the side of her face. She’s tried all the decongestants to no avail and decides to go to urgent care for antibiotics. She’s in and out in five minutes with the prescription.
Alternatively, if she goes to her primary care clinician, they can give her an antibiotics prescription — but they’ll also check her blood pressure, and may see it's elevated. They ask if her blood pressure tends to be elevated when she goes to the doctor, and she says no. They ask if she has a family history of high blood pressure or heart disease, and she shares that her mom had a heart attack in her 50s. Her doctor then recommends a blood pressure cuff to monitor at home and asks to see her again in two weeks to check on the infection and her blood pressure, accounting for both the near- and long-term view of the patient’s health.
Primary care is not just about solving one problem but taking care of the patient in the context of everything else. That's how we deliver personalized long-term care, helping patients optimize their health and well-being, so that they are empowered to make choices about their health that are consistent with their values.
Expanding access to lifelong care
Beyond not knowing or understanding the value of primary care, access to quality care is another major barrier that many people and populations face.
There’s a current shortage of primary care physicians, with a projected shortage of between 17,800 and 48,000 primary care physicians by 2034 — meaning we already don’t have enough clinicians to meet the needs of patients, and it may get worse. Meanwhile, many people put off seeing a primary care clinician regularly because of financial concerns, previous bad experiences, or limited time and resources to go in for a check-up.
That’s where the benefits of virtual care come into play. People in rural areas who previously had to drive hours to see a doctor — or parents who have no time for an appointment between work and their children’s schedules — can now access the care they need, quickly and effortlessly, thanks to various telehealth offerings.
Expanding access to care also unlocks an opportunity for people to find a primary care clinician they can connect with on a human level. Virtual visits allow patients to “shop around” more easily until they find someone they feel comfortable with, which is key to long-term success. The foundation of quality primary care requires a strong bond between the patient and clinician, especially knowing we will all come up against hard decisions regarding our health over time and will benefit from having a co-pilot we can trust.
As we continue to increase access and improve education around what primary care can achieve for people throughout their lifetime, I'm optimistic that we'll move towards equitable health outcomes and create more positive health experiences.
Dr. Nina Birnbaum is medical director of Innovation Acceleration at Blue Shield of California and has been with the company for over two years. Nina and her team recently launched Virtual Blue, the “virtual-first” preferred provider organization (PPO) plan that allows members to choose their network of doctors and specialists whom they can see virtually or in-person, without the need for referrals.
