Making New York City a primary care town

A primary care physician is your go-to clinician, the doctor you’ve developed a years-long relationship with, who knows your history, treats your family, and who, ideally, makes you feel safe and comfortable. But according to some experts, New York is some ways away from being able to call itself a “primary care town.”

At City & State’s Health & Wellness Summit today, a panel of policymakers and community health providers discussed the challenges facing New York’s primary care system, and some of the efforts being made to restore the primacy of primary care.

“Being a primary care town is where we really enable primary care to do everything it's capable of doing,” said Theodore Long, vice president for ambulatory care at New York City Health + Hospitals. “Is that our current state in New York State and New York City? I think we have a little ways to go to get there.”

Between 2012 and 2016, visits to primary care doctors in the U.S. declined 18 percent, according to a 2016 study by the Health Care Cost Institute, while visits to specialists increased. Primary care provides benefits that visits to specialists and emergency care can’t, including long-term disease prevention.

“If you cut a person up into his various diseases and send him off to the specialists, you're really not able to see the whole picture,” Louise Cohen, CEO of the nonprofit Primary Care Development Corp., said during the panel discussion

Some argue that the rise of urgent care and “minute clinics” set up by retailers like CVS and Walmart also pose a threat to primary care. Assemblyman and Health Committee Chairman Richard Gottfried argued that eventually, people will stop going to primary care providers for annual check-ups when they can address all of their health needs at drop-in clinics, and advocated for restrictions on these clinics.

“I think the horse is too far out of the barn to outlaw them, but I think we need to at least limit them to truly episodic, drop-in care, or else I think health care, in a very short period of time, is going to look very different in a way that we're not going to like,” said Gottfried, a Democrat.

State Sen. Kemp Hannon disagreed, saying that if these clinics had adversely affected primary care providers, those primary care providers would have complained about it.

“No one has said these urgent care centers are cutting in on their primary care practices,” said Hannon, the Republican chairman of the Senate Health Committee.

Another impediment to primary care visits is the fact that the system has not always appreciated the social determinants of health in minority and underserved communities. These social determinants include conditions like access to safe housing, quality education, affordable day care. Health care that doesn’t address these factors can result in a lack of patient trust in doctors.

“If we're going to improve the health of those individuals in the long term, it's a failing approach if we don't recognize how important it is to invest in what we now call the social determinants of health, or the context in which people live that actually creates health,” said Sonia Angell, deputy commissioner of prevention and primary care at the New York City Department of Health.

Gottfried pointed to the state Department of Health’s Doctors Across New York program, which provides loan relief for doctors working in underserved communities. “People relate better to a provider who they sense shares their background,” he said.

The high cost of medical school can also deter doctors from entering a primary care practice, as student debt can be more quickly repaid when doctors choose more lucrative specialties. This summer, New York University announced a new policy of free tuition for medical students – a move some hope will encourage graduates to pursue practices like primary care that are not as lucrative, but sorely in need of physicians. Whether or not it will work is yet to be seen.

“It's measurable,” Cohen said. “Today, according to the report that I have, NYU graduates 36 percent of its residents go into primary care. Let's see if that goes up. That'd be great.”