Primary care is where [as the word primary says] health care begins and hopefully ends for a great many folks, because the problem either was addressed promptly or was not too serious but did need a ‘band-aid’.

As with most things involving large populations, the first stage –and perhaps most important— is the weeding out stage which enables the succeeding phases to be more efficient and effective by focusing the more trained and experienced doctors to spend ALL their time working on what they were especially trained to do—not just doing the weeding out.

The new, and now rapidly growing, problem is that doctors and community health centers

[which see most people in need of help first before they go to hospitals]

are watching their populations of primary care doctors age and retire and at the same time they are having a VERY hard time rebuilding their essential base of primary care physicians.

There has long been a preference for doctors to go to densely populated areas where they can specialize easily with enough population to feed them with their type of cases.

The problem has gotten worse with the training in med schools focusing student interests in specialization. And, the ability of specialists to attract enough economic support to work, and to live the lives they want, they are led to ignore smaller less populated communities.

There are various ways this problem can be addressed in the smaller less populated areas.

The problem is that there are strict medical rules about what doctors can and can not do.

The consequence is that it is becoming more and more very difficult for local medical facilities to see all the people who “need to ‘see’ a doctor”.

A simple answer is to get more doctors. Unfortunately, that simple answer does not work the way the system operates today. That is not where enough doctors want or can afford to go. And those local communities—with rare exceptions—can not afford enough doctors to cover even their smallish populations.

A less simple, but in most cases, workable solution is to change doctor/assistant ratios. There are lots of new positions in medicine – physician’s assistants [PAs] as well as nurse practitioners [NPs] for example.

What is needed now is a top down and bottom up review of how best to utilize the skills and training that are already available and, in the system, and could be redeployed more efficiently. 

The aim here should be less what can not be done than what can be done. Solutions are always better than NO!

Where previously a local center ‘needed’ four or five doctors, but cannot get or afford 3, if they had 3 PAs and/or 3 NPs –one or two doctors could, most of the time, cover all the needs of that community.

But, frequently those local medical facilities do not have a strong enough voice to change the rules to enable them to provide that service.

Once again, we see ourselves governed by what sounds like rigid ‘union’ rules and sometimes even greed, at the expense of providing health care to their populations.