The Imbalance Between Primary and Specialty Physician Care

The healthcare system in the United States is in a crisis. Despite the consensus in the United States that primary care is a crucial component of the health care system, an imbalance still exists between primary care and specialty care systems. Physicians trained in the current system do not enter their local communities for private practice but instead, go into specialties and sub-specialties housed in teaching hospitals found in major cities. Primary care is the general health care which was traditionally provided by physicians trained in pediatrics, family practice and internal medicine. Primary care has been the backbone of the healthcare delivery system in the United States for many years. On the other hand, specialized health care is that which is provided by doctors trained in specific fields such as cardiology, dermatology, and oncology among other specialized areas. The paper aims to explore the causes of imbalance between primary care and specialty care by physicians, and analyzes measures that have been employed to mitigate the problem in addition to how effective the standards have been. 

Imbalance in the health care system is a significant problem for both healthcare policy-makers and citizens of the United States (Snavely, 2016) . The imbalance between primary care and specialty care physicians remains a considerable concern reported all over the world. For instance, between 1949 and 1970, there was a sharp decline in the supply of primary care doctors which has been on a slow decline since then. This resulted in an imbalance in the healthcare system. Despite the imbalance in the healthcare workforce being a significant aspect among policy-makers in the medical profession, there are various elements which contribute to this problem (Gupta, 2015) . The imbalance between primary care and specialty care in the United States is caused by the significant demand of specialists in the development of medical technology. This is because the need for specialty services has been on the increase in demand. Majority of patients who receive financial backing from third-party payment usually turn to specialists who can provide them with the latest sophisticated form of treatment. 

Higher income for specialists compared to primary care physicians has also contributed to the imbalance. For a long time, primary care physicians have been earning less than their specialties counterparts for comparable work majorly because payment of physicians has historically been based on total work effort and estimated practice costs. Furthermore, most insurance companies are willing to pay for complex diagnostic procedures using high technology and not for consultations and routine preventive visits. Practices such as these discourage potentially vital primary care services, encourages career choices in specialty services and discourages patients from seeking early preventive care. 

In addition to earning a higher income, specialists have more predictable working hours. Problems that have led to recruitment difficulties of physicians in the rural areas include less financial reward on services offered, more extended working hours, professional isolation and less access to technological models to diagnose this part of the medical field. Being a specialist physician also comes with a sense of prestige not only among colleagues but also to the public at large. 

The imbalance between primary care and specialty care has had various consequences. One of the effects of having more specialists is that they have been blamed for the high cost of health care service (Ono, 2016) . A high supply of surgeons increases the demand for initial surgeon contacts. Many operations operated now such as hip replacement, heart, and liver transplant were unknown decades ago. The technological development also entails new drugs for treating depression, heart diseases, and ulcers among others. 

To realize a better balance in the proportion of primary care and specialists care, physicians, more efforts are needed to enhance the specialty and geographic distribution of physician labor forces (Ono, 2016) . Medical schools should make every effort to develop the competencies of students in values, skills, and attitudes that are relevant to primary care practice. Medical school curricula should be oriented toward generalists such as disease prevention, public health, outpatient experience and provide students with opportunities to work in rural areas. 

Various measures have been taken to address the problem of imbalance between primary care and specialty care physicians. Most of these measures have been formulated in the form of programs aimed at increasing the number of primary care physicians. The migrant and Community Health Centre Programs is one example. The program provides primary care services to the less fortunate population using federal funds. Since the healthcare system of the United States mainly caters for the wealthy, many people, especially in rural areas suffer due to the lack of adequate primary medical services. 

A good example is the state of Texas which has the County Indigent Health Care Program (CIHCP) which offers healthcare services to residents who are eligible through the hospital districts, counties and public hospitals within the state. The program provided services, and counties are supposed to provide primary health care services to all residents. Educating medical students on the importance of serving in areas where the imbalance is present is crucial to making positive transformations (Ono, 2016) . 

The National Health Services Corps is a program that ties scholarship support to a future commitment to services in areas that are under-served (Ono, 2016) . The United States Armed forces has also employed a similar program by attracting medical students into the service while still in medical school. In return, the students are guaranteed employment and payment of all school fees. Recruiting professionals into programs managed federally like creates excellent opportunities to attract individuals who are service oriented. Imbalance becomes minimal as individuals volunteer to serve based on the needs of the military service, whether in a remote hospital or a large medical facility. This approach may be challenging to the private sector, but if large healthcare entities focus on attracting qualified doctors through incentives such as the ones mentioned above, there is more possibility of correcting the imbalance. 

Another measure to address imbalance is the support of primary care training programs and Area Health Education Centers. The state of Texas has a non-profit association of community health centers which represents many care providers in Texas. It has many registered members who work hard to meet the needs of underserved and uninsured individuals. This is a perfect example of private and government agencies collaborating to solve problems, in the community. The objective is to have a secure network of professionals dedicated to building a healthy state of Texas. 

Conclusion 

Measures such as community health programs, regulation of healthcare professionals and supporting primary care training programs are effective in addressing the imbalance in physician care. Just like all other professionals, attracting and keeping highly qualified and motivated healthcare physicians is the aim of any healthcare facility. No effective approach can solve every challenge in areas experiencing a shortage in physicians. Providing attractive opportunities for professional growth will give organizations and communities the necessary tools required to recruit physicians. Various measures have been taken to address the imbalance. Through the elaboration of specific rules highlighted in the paper, it is clear that the measures are effective in addressing the imbalance. For many years, primary care physicians have been the primary care providers to the less fortunate, minorities and people living in rural areas. The persistent shortage of primary care physicians could deny access to care to the under deserved population, and thus it is crucial for drastic measures to be taken to mitigate the imbalance between primary care and specialties care physicians. 

References 

Gupta, R., Bush, B. P., Dorsey, J., Moore, E., van der hoof Holstein, C., & Farmer, P. E. (2015). Improving the global health workforce crisis: An evaluation of Global Health Corps,  The Lancet Global Health ,  3 (11), e679. 

Ono, T., Schoenstein., M., & Buchan, J. (2016). Geographic imbalances in the distribution of doctors and healthcare services in OECD countries. 

Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United States,  Nursing Economics ,  34 (2), 98.