What are the intended goals of primary care, and what are the outcomes incentivized in our current system? As the two circles overlap less and less, the necessity of serious reconsideration and restructuring of not just primary care, but the American health care system becomes increasingly evident. 

Health & Medicine convened a Forum for Justice in Health Policy on Friday, May 12, 2023 to discuss the primary care crisis. The panel was moderated by Dr. Claudia Fegan, Chief Medical Officer at Cook County Health and board member at Health & Medicine. The speakers were Dr. LaMenta Conway, founder and board president at the I Am Abel Foundation; Dr. Eric Reinhart, political anthropologist, physician, and psychoanalyst at Northwestern University; and Dr. Steven K. Rothschild, department chair of family medicine at Rush Medical College. You can watch a recording of the panel here. 

To start off, Dr. Reinhart emphasized the need for all of us to agree on an expansive definition of primary care itself, one that includes not just medical care but the basic services that deal with the many social determinants of health such as housing, food, and community. We might reimagine primary care as not just the doctor’s visit but also community health workers, access to social services, and more. 

Dr. Fegan pointed out that instead, the corporatization of primary care has led to people perceiving their primary care physician as an obstacle to specialist care. Physicians and patients are treated, as Dr. Rothschild says, interchangeable “widgets” rather than human beings. Reducing medical visits to billing codes degrades trust in the health care system and deprives physicians of the human connection that many of them went into medicine for. 

Dr. Rothschild provided an example of the immeasurable value of the trust a provider can build in health care—-his experience treating four generations of a family, leading the granddaughter of a patient to open up to him about concerns she’d never previously told a doctor. A longitudinal relationship like that makes both the patient and provider more comfortable and better able to address any and all needs. 

Right now, primary care is not an appealing field to go into, which is part of why there is a serious shortage of providers. Those working in primary care are underpaid and often overworked.  

How much does our society prioritize public health? Without paid sick leave, universal health care, or other meaningful social welfare infrastructure, it’s clear that health is not the priority. For more relationship-based, holistic health care, everything from the lack of access to STEM education to limited number of residency spots to the vertical integration and large-scale private acquisition of health care companies needs to change. 

You can watch a recording of the panel here. If you’re interested in reading more about this subject, Health & Medicine has developed a reading list to help. Health & Medicine has also made a summary of primary care relevant loans and scholarships that exist in Illinois right now.