While you are the quarterback for your healthcare team, your primary care physician is your coach – without him or her – you wade aimlessly around the healthcare maze. Your primary care physician should work to keep you healthy, refer you to specialists and basically make sure nothing slips through the cracks. Problem is, the number of medical school students going into primary care continues to decrease each year. Worse yet, the number of primary care physicians leaving the practice of medicine is increasing. The main reason for this defection is the reimbursement rates for primary care physicians compared to specialists. It could take decades before some of the government and medical school programs incentivizing more grads to enter primary care actually have an impact – if ever. In the meantime, what’s a patient to do?
Who else, if anyone, can fill the shoes of a primary care physician. If given the choice, most patients would choose a board certified family practice physician or internal medicine physician as their primary care practitioner. However, if you don’t have physicians available to you, it is important to understand what your options are. Your choices should be driven by your own beliefs in healthcare treatment and levels of comfort with different practitioners. It is also important to determine whether your health plan will reimburse you for care provided by some of the practitioners noted below. In possibly selecting one of these alternative practitioners to guide your healthcare, you will want to ensure that the practitioner is licensed to practice in your state.
- Physician “extenders”. This group includes physician assistants and nurse practitioners. They receive more traditional training than nurses, but less than physicians. These individuals often practice with a physician, but some states allow physician extenders to practice independently. Because the supply of physician extenders is larger than primary care physicians, your likelihood of finding one to care for you is high.
- Naturopathic doctors (NDs) Naturopathic doctors are licensed and regulated in 14 states currently, but the number is growing. NDs are trained specifically to provide primary care and patient management using a holistic and natural approach. They are also trained to readily identify when a patient needs to be referred for specialized treatment and care. The Council on Naturopathic Medical Education accredits the 6 naturopathic schools and provides lists of licensed practitioners by state.
- Oriental medicine practitioners...These practitioners are licensed and regulated for the practice of traditional oriental medicine which includes management of patients through acupuncture, acupressure, and herbal diagnosis and treatment by the states where they practice. In order to take the national certification exam, a pre-requisite to licensure, the practitioner must have graduated from a program in Oriental Medicine accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). Currently, the association accredits 49 programs in the U.S.
- Chiropractors (DCs). Doctors of Chiropractic medicine practice a drug-free, hands on approach to healthcare that includes physical examination, diagnosis and treatment. DCs are holistic healthcare practitioners in that they treat the entire patient, not just a specific diagnosis. Most are well versed in nutrition and other natural approaches to healthcare. They are licensed by the states where they practice.
- Ayurvedic Medicine Ayurvedia is a form of medicine practiced in India for centuries. It is not currently regulated in the US. There are however, several physicians like Jay Glaser, MD, who manages the Lancaster Ayurvedic Medical Centers in Massachusetts who are used as a primary care resource by many patients. You can find out more information about Ayrvedic Medicine from the Alternative Medicine Foundation, founded by Deepak Chopra, MD. www.amfoundation.org
CAVEAT EMPTOR: If you elect to go the alternative route for primary care, you should (1) verify the practitioner is licensed (2) obtain references, from other professionals and patients (3) verify that the practitioner has relationships with traditional practitioners and will be able to readily refer you to the correct medical or surgical specialist if necessary (4) for alternative practitioners, do some research on the type of medicine they practice to make sure you are comfortable with their approach.
Ruthann Russo, PhD, JD, MPH, RHIT, is a healthcare expert with more than 20 years of experience working in and advising healthcare organizations.
