We had a very interesting discussion this week at a community meeting on creating access to primary care. At the very time we are giving more people health coverage, we have less access. Why? Physicians are retiring and not being replaced Fewer medical students are choosing primary care as a profession, and our aging population needs more care.

I also see a trend among some people who choose locations for one stop shopping, versus multiple sites. That tends to promote urgent care, and emergency rooms nights and weekends. So how do we expand access and recruit for primary care?

First, who provides it? Family medicine physicians, internists, nurse practitioners, physicians assistants and many specialists, out of necessity, have been providing primary care to certain groups of patients.

Where do they provide it? Community based offices, health system-sponsored clinics and practices, federally qualified health centers, emergency rooms, urgent care centers, nurse led clinics, and most recently, store based offices.

Regulations differ from state to state, and this access is different depending on locations. Rural communities are facing huge problems as recruitment has become more competitive. So what can we do to increase the number of primary care providers? We can examine the obstacles including:

1.  Expansion of the number of residency slots allowed. 

2.  Increasing  the loan forgiveness for physicians and clinical affiliates who choose primary care.

3.  Increasing salary levels to attract people to the field.

4.  Looking at regulations that limit appropriate practice of clinical affiliates.

5.  Medical schools have to do a better job promoting the profession.

What other ideas do you have as health care experts to improve primary care access in the future? What can St. Joseph's do and how do we as a community create a focused effort we can all participate in supporting? Share your ideas on my blog and we will in turn share them with our regional health planning group.

Lastly, I want to thank all the primary care providers who care for our community and to let you know how much we and our families appreciate what you do every day, often without adequate recognition and thanks for the choice of career you made.  It's because of you that we are healthy and engaged in our careers and families. There are many other choices you could have made, and you chose to care for our families. Thank you.