Primary care physicians get fewer than half of acute care visits

Americans with stomach pain, coughs and other acute ailments see primary care physicians less than half the time, according to a study in the September issue of Health Affairs.

Just 42% of the 354 million annual acute care visits are to primary care doctors. The rest are to emergency departments, specialists or outpatient facilities.

The study highlights the need to increase access to care and to serve patients better by encouraging more physicians to go into primary care, said Stephen Pitts, MD, MPH, lead study author and associate professor of emergency medicine at Emory University School of Medicine in Georgia.

"We have to make primary care a high-status profession," he said.

Low payment and high demand for care mean that most primary care doctors race from patient to patient every 15 minutes "like a hamster in a cage turning a wheel all day," said Arthur Kellermann, MD, MPH, one of the study's authors and senior principal researcher at the RAND Corp. in Virginia.

Researchers analyzed data from 2001-04 surveys by the National Center for Health Statistics to learn where patients go when they become sick or injured (link). The study showed that 28% of patients went to emergency departments. One in five patients went to a specialist, and 7% went to hospital outpatient centers.

Uninsured patients were most likely to go to EDs, while general practitioners and pediatricians saw mostly privately insured patients.

Emergency physicians make up about 4% of the physician work force but provide a large portion of care, Dr. Kellermann said.

Angela Gardner, MD, president of the American College of Emergency Physicians, said it's a common myth that too many patients misuse EDs for care they should get elsewhere. Patients who misuse EDs account for only 8% of ED cases, she said.

"Everyone is saying that if you just get rid of those nonemergency cases, then everything will be OK. That isn't the case," she said.

Many patients don't have other options, especially if they need care in the evening or on a weekend. "We see 96% of all after-hours patients," Dr. Gardner said. "If you're a patient and you're sick and you need care, where else are you going to go?"

The health system reform law is expected to increase funding for primary care and extend coverage to 32 million uninsured Americans. But the medical profession needs to be made more attractive to increase the work force, Dr. Pitts said.

"If primary care capacity lags behind rising demand, patients will seek care elsewhere," the study said. "If reimbursement rates are too low to interest office-based physicians in treating patients with public insurance, such patients may have no choice but to head to the nearest emergency department."