Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
Ann Fam Med. 2022 Sep-Oct;20(5):464-468. doi: 10.1370/afm.2858.
This 2-part essay offers a discussion of the health of primary care in the United States. Part 1 argues that the root causes of primary care's problems are (1) the low percent of national health expenditures dedicated to primary care (primary care spending) and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access.Information used in this essay comes from my personal clinical and policy experience bolstered by summaries of evidence. The analysis leans heavily on my visits to dozens of practices and interviews with hundreds of clinicians, practice leaders, and practice staff.In 2016, the United States spent approximately 5.4% of total health expenditures on primary care, compared with an average among 22 Organization for Economic Co-operation and Development (OECD) countries of 7.8%. With average US primary care panel size around 2,000, it would take a clinician without an effective team 17 hours per day to provide good care to that panel. Low primary care spending and excessive panel sizes are related because most medical students avoid careers featuring underfunded practices with unsustainable work-life balance.Over the past 20 years, many initiatives-explored in Part 2 of this essay-have attempted to address these problems. Part 2 argues that to revitalize primary care, 2 fundamental changes are needed: (1) increased spending dedicated to primary care and (2) creating powerful teams that add capacity to care for large panels.
这篇由两部分组成的文章探讨了美国初级保健的健康状况。第 1 部分认为，初级保健问题的根本原因是：(1) 用于初级保健的国民卫生支出比例较低(初级保健支出)；(2) 患者群体过大，没有团队的临床医生无法管理，导致广泛的倦怠和患者就诊困难。本文中使用的信息来自于我个人的临床和政策经验，辅以证据摘要。该分析主要依赖于我对数十家诊所的访问以及对数百名临床医生、诊所领导和诊所工作人员的采访。2016 年，美国用于初级保健的支出约占总卫生支出的 5.4%，而经合组织(OECD)22 个国家的平均水平为 7.8%。由于美国初级保健的平均患者群体规模约为 2000 人，没有有效团队的临床医生每天需要 17 个小时才能为该群体提供良好的护理。初级保健支出低和患者群体过大是相关的，因为大多数医学生避免从事资金不足、工作与生活平衡不可持续的实践。在过去的 20 年里，许多举措——在本文的第 2 部分进行了探讨——已经尝试解决这些问题。第 2 部分认为，要振兴初级保健，需要进行两项根本性变革：(1) 增加用于初级保健的支出；(2) 建立强大的团队，为管理大型患者群体增加能力。
