Primary-care physicians help increase life expectancy. So why is there a shortage?

What if there were a miracle pill that could extend people’s lives? And instead of causing side effects that make you feel sicker, it makes you healthier? Not only toward the end of your life, but throughout your entire life. What if instead of adding billions of dollars in health-care spending, it saved money?

My guess is that most people would say this is too good to be true. And they’d be right: There is no such miracle pill. But there is something that we know would do all of these things, that’s been around for a long, long time, yet is becoming ever harder to find: primary-care physicians (PCPs).

A new study found that “each additional 10 primary-care physicians [in a U.S. county] per 100,000 population was associated with 52 days more in life expectancy.” In other words, the more primary-care doctors practicing in a county, the longer people in that county will live, on average.

This is by no means the only study that shows the value of primary care. A 2012 review of research on the impact of primary care both in the United States and internationally found “that countries and regions more oriented to primary care have lower health-care costs but better health outcomes” and that “better primary care is correlated with more equitable distribution of health within a population … which is especially important in the USA, where racial and ethnic minorities face greater difficulties accessing regular primary care.”

It makes sense that being cared for by an internist, family physician, or pediatrician helps keep patients healthy; allows for early diagnosis of diseases that, if left undetected, could lead to more serious (and expensive) conditions later; and results in better coordination of care with other specialists.

That’s the good news. Here’s the bad: Per capita PCP supply (the number of PCPs per person in a county) decreased between 2005 and 2015. It’s estimated that there will be a shortage of 14,800 to 49,300 primary-care physicians by 2030. The likely result will be that fewer people will have access to a PCP, costs will go up, people will be sicker, and many may die younger.

If primary care is so valuable, why isn’t more being done to train more PCPs and address the reasons many medical students are choosing other fields?

One reason is that “care provided by PCPs accounts for a small fraction of total spending among Medicare beneficiaries,” according to a new Rand Corp. study published in the journal JAMA Internal Medicine. Primary-care spending represents 2 percent to 4 percent of total medical and prescription spending by Parts A, B, and D of the Medicare program. By spending less on primary care than other health-care sectors, the U.S. has essentially made a choice not to invest in producing and sustaining primary care. PCPs are also paid less than other specialists.

Additionally, PCPs bear more “check the box” administrative burdens that take time away from patients. Primary care is often portrayed as being less prestigious than, say, orthopedic surgery. It’s also hard having to know the full gamut of disease conditions that may crop up among their patients, spending the time to get to know them over the course of their lifetimes, and quarterbacking their care with other specialists when they get sick, compared with specialists who treat one disease or condition on an episodic basis. It is also what most primary-care physicians like most about what they do.

If primary care is the miracle cure to much of what is wrong with American health care, it’s time for politicians, policymakers, and payers to put money, resources, and policies in place to nurture and support primary care, just as they would if there were a new pill or procedure that would help everyone live longer and healthier while lowering costs.

Robert B. Doherty is senior vice president of governmental affairs and public policy for the American College of Physicians and a member of the Inquirer’s Health Advisory Panel.