Health Tech

3 key reasons why Americans are under-utilizing primary care

In order to engage more Americans in primary care, we need to understand the main challenges that surround primary care in the U.S., according to Dr. Stephen Ezeji-Okoye, Crossover Health’s chief medical officer. Some of these include the increasing shortage of primary care physicians and the lack of incentivization to focus on whole-person health and preventive care.

Many Americans find it difficult to engage with primary care. In fact, statistics show that as many as 25% of Americans do not have a primary care provider.

In order to address this problem, we need to understand the main challenges that surround primary care in this country, said Dr. Stephen Ezeji-Okoye, Crossover Health’s chief medical officer, during a recent interview after his panel session at Reuters’ Total Health conference in Chicago. His company is a national medical group focused on wellbeing and preventive healthcare.

Lack of focus on whole-person health and preventive care

Patients usually go to their providers when they have a health problem that needs to be addressed. Weeks-long appointment wait times, coupled with the expensive nature of healthcare in this country, means that very few patients make appointments to have conversations with providers about the general state of their health, according to Dr. Ezeji-Okoye.

Since primary care providers have to focus their energy on treating the problems that patients come in with, they do not have much of an opportunity to ask questions that could tackle the root causes of health issues, such as ‘Why do you drink frequently?’ or ‘What factors are preventing you from exercising?’, Dr. Ezeji-Okoye said.

“Inspiring behavior change takes time, and it really isn’t compensated for within our current healthcare system,” he said. “So as a result, this often takes a back seat to what providers can do in a fee for service world.”

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Patients’ misconceptions about primary care

Since the medical industry often touts impressive advancements in care, many patients have fallen into a trap where they believe there will likely be a drug or procedure that can fix their health issue, according to Dr. Ezeji-Okoye. 

He said this often leads to a lack of understanding of just how impactful behavioral changes can be.

For example, diabetes might seem inevitable to a person whose parents and grandparents had the disease. They know that there’s insulin to treat the problem, and they may have accepted their fate before even being diagnosed. But had a primary care provided engaged them early on and put them on a healthier track, there is a chance they could have avoided the condition, Dr. Ezeji-Okoye said.

Shortage of primary care providers

The country’s dearth of primary care providers might be biggest problem surrounding primary care, with experts projecting that the U.S. will be short between 17,800 and 48,000 primary care physicians by 2034. One of the reasons that has caused this shortage is that there is a “significant difference” in the way that primary care physicians are paid, according to Dr. Ezeji-Okoye.

“Most of primary care is about talking and interacting with people — it’s not always about interventions. But the payment system really favors interventions,” he said. “So while you do get paid for visits, the only way to increase revenue is to do more visits. And so that pushes you to shorter appointment times and seeing more patients in the day.”

This problem not only leads to physician burnout, but also patient dissatisfaction. 

Dr. Ezeji-Okoye contends that primary care is fundamentally based on physician-patient relationships — it is difficult to build a relationship if you’re only spending 10 or 15 minutes with a patient. Having a 10-minute visit that you waited a month and a half for is not exactly a positive experience, and these negative experiences make patients less likely to return to primary care, Dr. Ezeji-Okoye pointed out.

Photo: Geber86, Getty Images