Primary care is health care’s first point of contact for many patients and is often recognized as the crucial foundation of any health care system, but primary care in the United States has been weakened by insufficient investment, limited access, and widespread clinician burnout. An increased focus on enhancing patient experience by reinforcing clinician-patient relationships could help strengthen primary care, improve health outcomes, and mitigate the effects of burnout.
Primary care in the United States has been hindered by underinvestment affecting primary care supply, access, and care experience. Despite substantial evidence linking effective primary care to disease prevention, the reduction of health disparities, and increased population health, annual spending on primary care services has become stagnant and accounts for only 5% of all U.S. health care spending.1,2 The rate of primary care office visits in the U.S. has decreased in recent years, along with the number of primary care providers per capita.3 Adequate access to primary care presents a growing challenge for 100 million Americans living in Designated Health Professional Shortage Areas, and the American College of Medicine projects there will be a shortage of up to 48,000 primary care physicians by 2034.4,5
Clinician burnout, characterized by emotional exhaustion, depersonalization, and lack of a sense of personal accomplishment, is widely prevalent among primary care clinicians and further threatens access to quality primary care.6 Burnout is influenced by excessive workload and lack of autonomy and has been linked to increased medical errors, worsened physician health, and an increased likelihood of physicians to leave their practices.7
These have influenced the delivery of primary care over time; systems have increased emphasis on cost and reimbursement efficiency, sometimes to the detriment of the “personal” aspect of patient care. As physicians have been tasked with seeing more patients, office time spent with patients has decreased in recent decades and hands-on physical assessments have diminished in favor of laboratory testing.8
Although many of the challenges facing primary care in the U.S. are complex, large-scale issues, an increased focus on strengthening clinician-patient relationships and designing patient-centered care may offer an avenue for elevating primary care within the confines of the current health care system. Research suggests a positive relationship between patient experience, physician satisfaction, and health outcomes. Improved physician-patient relationships have been linked to improved functional health, while better patient experience is correlated with lower physician burnout rates.9,10 Effective interpersonal communication, a basis for strong relationships, is also crucial to the delivery of care and is connected to higher rates of patient trust and adherence to medical advice.11 By centering primary care attention on the personal relationship between patient and clinician, primary care practices may be able to realize increased health outcomes in tandem with improved physician satisfaction.
The Midwest Health Initiative (MHI), a health improvement collaborative based in St. Louis, Missouri, is launching an interactive local forum series to advance primary care in the region by connecting primary care clinicians with purchaser and payer leaders to create dialogue concerning opportunities to strengthen primary care.
MHI’s Community Connections forum, slated to kick off June 5th, 2024, recognizes the importance of patient experience in primary care improvement with its inaugural topic. The event will offer intervention examples that other regions have used to enhance patient experience in primary care and open a discussion for local clinicians to discuss their experiences and find solutions that work for the community. Through these events, MHI intends to amplify the voices of primary care clinicians to other health care stakeholders and inspire positive change within the health care system.
MHI’s organizational mission is to provide a forum where trusted information and shared responsibility are used to improve health and the quality and affordability of health care, and the non-profit has previously organized workgroups focused on primary care. Founded in 2022, MHI’s Realizing Effective Affordable Change in Healthcare (REACH) workgroup is a multi-stakeholder initiative with goals to control health care spending growth and to drive “advanced primary care” in the region. With Community Connections, MHI hopes to build on its existing community work and complement the efforts of its REACH partners.
To learn more about the Midwest Health Initiative and its community projects, visit www.midwesthealthinitiative.com.
References:
Jabbarpour Y., Petterson S., Jetty A., Byun H.,The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care, The Milbank Memorial Fund and The Physicians Foundation. February 22, 2023.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Implementing High-Quality Primary Care; Robinson SK, Meisnere M, Phillips RL Jr., et al., editors. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington (DC): National Academies Press (US); 2021 May 4. 3, Primary Care in the United States: A Brief History and Current Trends. Available from: https://www.ncbi.nlm.nih.gov/books/NBK571806/
https://data.hrsa.gov/topics/health-workforce/health-workforce-shortage-areas
IHS Markit Ltd. (2021) The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. Washington, DC: AAMC; http://resource.nlm.nih.gov/9918417887306676
Clifton, J., Bonnell, L., Hitt, J., Crocker, A., Rose, G. L., van Eeghen, C., Kessler, R., Stephens, K. A., Teng, K., Leon, J., Mollis, B., & Littenberg, B. (2021). Differences in Occupational Burnout Among Primary Care Professionals. Journal of the American Board of Family Medicine : JABFM, 34(6), 1203–1211. https://doi.org/10.3122/jabfm.2021.06.210139
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences and solutions. Journal of internal medicine, 283(6), 516–529. https://doi.org/10.1111/joim.12752
Drossman, D. A., & Ruddy, J. (2020). Improving Patient-Provider Relationships to Improve Health Care. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 18(7), 1417–1426. https://doi.org/10.1016/j.cgh.2019.12.007
Olaisen, R. H., Schluchter, M. D., Flocke, S. A., Smyth, K. A., Koroukian, S. M., & Stange, K. C. (2020). Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health. Annals of family medicine, 18(5), 422–429. https://doi.org/10.1370/afm.2554
McKee, K. E., Tull, A., Del Carmen, M. G., & Edgman-Levitan, S. (2020). Correlation of Provider Burnout With Patient Experience. Journal of patient experience, 7(6), 931–936. https://doi.org/10.1177/2374373520902006
Burt, J., Campbell, J., Abel, G., Aboulghate, A., Ahmed, F., Asprey, A., Barry, H., Beckwith, J., Benson, J., Boiko, O., Bower, P., Calitri, R., Carter, M., Davey, A., Elliott, M. N., Elmore, N., Farrington, C., Haque, H. W., Henley, W., Lattimer, V., … Roland, M. (2017). Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. NIHR Journals Library.
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