Challenges in Selecting a New PCP: 64 + Years/Medicare Segment
The challenges that Americans who are aged 64+ are facing when selecting a new PCP include ageism in the healthcare sector and issues in the accessibility of PCPs in rural America. On the other hand, the challenges the general public faces when selecting a new PCP includes a lack of choice and a shortage of primary care physicians. A detailed overview of the research findings follows below.
1. Ageism in the Healthcare Sector
- Ageism is ” the stereotyping and discrimination against individuals or groups on the basis of their age. Ageism can take many forms including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs.”
- In the American healthcare system, ageism is a challenge that people aged 65 years and above face when selecting a new PCP because there hasn’t been a major change in how doctors are trained and in their attitudes towards older patients.
- As a result, it is harder for older patients to find a PCP that will fully match their medical needs as they continue to age. The fact that medication-related problems are one of the top five causes of death for Americans aged 65 and older shows that compatibility between PCPs and the needs of older patients seeking new providers is very low.
- Additionally, 1 in 3 seniors that take more than five medications will have at least one bad drug reaction annually and a third of them will require medical attention while people aged over 65 are 2.5 times more likely to require a visit to the emergency room for a bad drug reaction than younger people.
- The above statistics show that ageism in the healthcare system can be a major challenge when people aged 64 and above go out looking for new PCPs.
2. Accessibility of PCPs in Rural Communities
- Out of a total of 5,198 community hospitals in the United States, 3,377 hospitals are in urban communities while 1,821 hospitals are in rural communities.
- As for the population of rural communities in the country, 1 in 5 older Americans live in rural areas while a large number of them are concentrated in states where over 50% of their older residents live in rural areas.
- According to the American Community Survey (ACS) data for the period 2012-2016, out of 46.2 million older people in the United States, 10.6 million resided in areas designated as rural.
- From the above statistics, it is evident that accessibility to PCPs is another challenge that people aged over 64 years face when looking for new PCPs. The fact that most older people in the United States reside in rural communities that have a lower number of hospitals than urban communities clearly highlights this problem.
Challenges in Selecting a New PCP: General Public
1. Lack of Choice
- When people in the general population go out to look for new PCPs, they usually face a problem in finding a PCP that can best cater to their health needs. This is because, in the United States, each “general practitioner has a particular way of working with patients and promoting their health, which is more compatible with some patients than others.”
- Consequently, a lack of choice when it comes to selecting a new PCP is a real challenge that people face in the American healthcare sector. In some areas, especially in rural communities, there is a significant lack of choice that results in patients not receiving all the benefits of primary care as they don’t have access to a PCP that is well suited to meet their health needs.
- This absence of choice leads to people choosing the next best PCP and this can affect the quality of healthcare services people are exposed to as a mismatch between a PCP and patient may mean the patient will not receive all the healthcare benefits of having a primary care provider.
2. Shortage of Primary Care Physicians
- According to the Washington Post, the United States is expected to have a shortage of PCPs within the next decade. The reason behind this is that the graduates of American medical schools are less likely to choose to specialize in medical fields that are related to primary care.
- In 2019, a record-high number of PCP positions were offered through the National Resident Matching Program that was known as the Match. In 2020, this was not the case because “the percentage of primary care positions filled by fourth-year medical students was the lowest on record.“
- The three key primary care fields are — internal medicine, family medicine, and pediatrics. In 2019, around 8,116 positions in internal medicine were offered via the Match program, but only 41.5% of the positions were filled by seniors pursuing medicine in U.S. schools.
- The Association of American Medical Colleges predicts that by 2032 there will be a shortage of between 21,100 and 55,200 PCPs. This shortage which is already being experienced poses a challenge to people that are trying to identify a new PCP because the number of physicians is declining at a steady rate and finding a PCP that is best suited to a patient’s needs will continue to become harder.
Considerations When Selecting/Evaluating New PCP: 64 + Years/Medicare Segment
The considerations that patients aged over 64 years/the medicare segment make when selecting/evaluating a new PCP includes the location of the PCP offices and whether the PCP accepts medicare or not. On the other hand, the considerations that the general public makes when selecting/evaluating a new PCP include the fit of the PCP to the health needs of the patients and the gender of the PCP. A detailed overview of the research findings follows below.
1. Location of PCP Offices
- Location is a key consideration for patients under medicare when they are selecting or evaluating a new PCP. This is because PCPs attend to a patient’s everyday healthcare needs and the closer they are to each other the better.
- Medicare caters to the older population and it is usually not ideal for them to travel long distances when they are not feeling well. Additionally, when the PCP’s office is closer to the patient, they will be more inclined to “keep appointments for physicals and other preventive care when they are healthy.”
- Location and ease of accessibility is an important consideration for the older population segment and the medicare segment because a study by the University of Michigan Medical School found that the odds of a patient’s recovering reduces as the distance from their PCP increases.
- Location and accessibility affect the selection of a PCP by older patients because it facilitates convenience in seeking healthcare services and ensures patients can go to all their scheduled visits including preventative visits when they are not sick.
2. PCPs that Accepts Medicare
- Another consideration that older patients who are under medicare make when selecting a new PCP is whether or not the PCP accepts medicare.
- This is an important consideration because patients may be charged a higher rate for visits and services they receive if they select a PCP that does not accept medicare. This means that healthcare may become considerably more expensive under other payment alternatives.
- This is a major consideration for the medicare segment because most people under medicare would want to select PCPs, doctors offices, and health networks that accept medicare health plans.
- Resources that patients can use to determine whether a PCP accepts medicare or not include Physician Compare, the Medicare website, friends and family members, and insurance company provider listings.
Considerations When Selecting/Evaluating New PCP: General Public
1. PCP Fit to Patient Healthcare Needs
- An important consideration when selecting a new PCP for the general public is the fit of the PCP to the healthcare needs of the patient. This is because different types of PCPs attend to different types of patients and cater to different healthcare needs.
- For instance, a family medicine provider and an internal medicine provider are different and the difference “in training fosters unique skill sets between the two specialties that patients can consider when choosing a primary care doctor.”
- Family medicine doctors cater for patients of all ages from birth to death including prenatal, obstetric, gynecologic, pediatric, adult, and geriatric care while internal medicine doctors normally offer care for adults starting at 18 years and may refer out for other healthcare needs. Consequently, patients consider selecting PCPs that meet their particular health problems, concerns, and needs.
- This consideration affects the selection of PCPs because most people want to select providers that have the necessary skill set to cater to their healthcare needs and problems.
2. Gender of the PCP
- Another major consideration that patients in the general public make when selecting a PCP is the gender of the provider. Different patients feel more comfortable with providers of different genders because of the familiarity of the provider to the healthcare needs of the gender.
- For instance, because healthcare is deeply personal, patients can prefer male, female, or LGBT-friendly PCPs. Anxiety and discomfort that is based on gender mismatch can “negatively impact the interactions between patients and their PCPs and impair their ability to diagnose and treat a patient’s medical conditions.”
- Statistics also show that LGBT patients face discrimination and hostility when they seek healthcare services. This patient group might thus feel more comfortable with PCPs that are friendly to the LGBT community. According to a survey by the National LGBTQ taskforce, around 50% of respondents reported that they had to teach their medical providers about transgender care.
- The gender compatibility between PCPs and patients in the general public affects provider selection because even though gender does not dictate the competence or compassion of doctors, comfort in discussing certain health issues with a doctor of the same sex can result in better outcomes for the patient.
Factors that Influence/Discourage PCP Switching: 64 + Years/Medicare Segment
The factors that influence/discourage PCP switching in the population group of people aged over 64 years/the medicare segment include the quality of the relationship between PCPs and patients, the need for specialized care for older patients, and the medicare status of the PCP. On the other hand, the factors that influence/discourage PCP switching for the general public include technological advancement in the healthcare sector, a patient’s healthcare plan, and the level of patient satisfaction with PCP healthcare services. A detailed overview of the research findings follows below.
1. Quality of Relationship Between PCP and Patient
- In the United States, the quality of an older patient’s relationship with a PCP is one of the factors that influences PCP switching in the 64+ years patient category.
- When older patients feel that the quality of their PCP-patient relationship does not meet their minimum expectation, they may choose to switch PCPs.
- Older patients have a higher need for primary care because they have “unique needs which are different from other patient populations” and a high quality relationship with their PCP can result in better health outcomes.
- This factor influences PCP switching because older patients have an expectation of having a good medical relationship with their primary care physician.
2. Need for Specialized Care
- As Americans transition into the 64 + years age group, their health needs from PCPs also begin to change. This is because an aged body is different from a young body in physiological terms and this means that older patients tend to have more severe disease states that can lead to longer hospital stays.
- The delicate state of the bodies of older patients necessitates a need for specialized primary care from physicians that have an understanding of an aging body such as geriatricians.
- It is important that older patients have geriatricians as PCPs because they specialize in treating the complex medical needs that aging patients require.
- This factor influences PCP switching because as the health needs of aging patients change, so will their need for PCPs that offer specialized care that is custom to the needs of their aging bodies.
3. Medicare Status of the PCP
- Medicare is the federal health insurance program that most of the people that are aged over 65 years are on. This programs helps with the cost of the healthcare of older people.
- Consequently, another factor that can influence/discourage PCP switching within the older American population is the medicare status of the care provider. If the medicare status of a PCP changes, an older patient would be influenced to switch PCPs and if the medicare status of a PCP that a patient wants to switch to is not favorable, they may be discouraged to switch PCPs.
- This particular factor is the reason why the federal government has the Medicare Compare portal that older patients can use to find preferred health professionals (PHPs) within their area of residence.
- This factor influences PCP switching because the medicare status of a provider dictates how much an older patient would have to pay for primary care and associated health needs.
Factors that Influence/Discourage PCP Switching: General Public
1. Technological Advancements
- According to the Telehealth Index: 2017 Consumer Survey, 20% of consumers or 50 million consumers would switch “to a PCP that offers video visits if another PCP in their area offers them.”
- This results from a telehealth survey show that a key factor that influences PCP switching in the United States is the technological advancements that are present in the American healthcare sector.
- Patients in the general population have an interest in using technology to communicate with PCPs as 65% of respondents to the above survey noted that they were interested in seeing their PCP over video technology.
- This factor influences PCP switching within the general population because consumers are out searching for more convenient access to healthcare and they are also willing to switch to providers that offer telehealth for health needs that include chronic conditions and post-discharge follow-ups.
2. Patient’s Healthcare Plan
- Health insurance plans dictate PCP switching because different plans support particular PCPs, health systems, and networks.
- Consequently, the healthcare insurance plan that a patient is on can influence/discourage PCP switching. This is because if patients decide to see a PCP that is outside the network of covered institutions, they would need to pay more out-of-pocket.
- This factor is a key influence of PCP switching and that is the reason why patients are advised to look at the provider networks offered by insurance plans when they are considering purchasing a health insurance plan. This is to ensure they know all the PCP switching options that are available to them before they purchase health insurance plans.
3. Patient Satisfaction with PCP Healthcare Services
- The final factor that influences/discourages PCP switching within the general population is the level of satisfaction that patients have with the healthcare services they receive from a PCP.
- Before selecting a PCP, people are advised to consider the compatibility of the PCP to their healthcare needs as this determines whether providers will be able to meet the care needs of their patients.
- As a result, patients that are not satisfied with the healthcare services they receive from their PCP may be influenced to consider switching to a PCP that is more compatible with their healthcare needs. On the other hand, patients that are satisfied with the primary care services they receive from PCPs are in normal circumstances discouraged to switch providers.
Impact of COVID on PCP Switching: 64 + Years/Medicare Segment and General Public
The impacts of COVID on PCP switching in the population group of people aged over 64 years/the medicare segment and the general population include increased switching to PCPs that also offered telehealth and telemedicine services and a decrease in PCP business. A detailed overview of the research findings and research strategy follows below.
1. Switch to PCP Telehealth Providers
- The COVID pandemic resulted in lockdown and social distancing regulations that in turn resulted in decreased visits to PCPs.
- With decreased visits, patients considered switching to PCPs that offer telehealth and telemedicine services. Industry experts point to the increased utilization of telemedicine during the COVID pandemic as one of the positives of the pandemic.
- In 2019, only around 15% of physician practices were using telehealth for patient care. However, the switch to telemedicine that was influenced by the pandemic resulted in physician practices rapidly acquiring and implementing telehealth systems and currently around 70% of practices are using telehealth.
2. Decrease in PCP Business
- The COVID pandemic resulted in decreased business for PCP businesses as they “actively discouraged patients from coming into the office for routine care to prevent the spread of COVID.”
- Even before the pandemic, PCPs were on a steep decline dropping by 24.2% over the 2008-2016 period. In this period, visits to alternative care sites such as emergency departments and retail medical clinics increased by 46.9%.
- From the above statistics, it was concluded that the COVID pandemic negatively impacted PCP businesses by resulting in decreased activity in the market including PCP switching.