Not all physician specialties are created equal, at least not in the United States. The relative pecking order of American doctors has, for decades, placed primary care (internal and family medicine) below interventional specialties like cardiology, orthopedics and oncology.
Though it’s hard to tell which came first, the lower pay or diminished status, primary care has long remained at or near the bottom of the national healthcare hierarchy and economic structure—with no apparent relief or course correction in sight.
This week, I joined the Primary Care Collaborative (PCC) monthly webinar, alongside the organization’s CEO Ann Greiner and X4 Health President Christine Bechtel, to discuss the role of primary care in the culture of medicine, the healthcare system and the ever-evolving clinician-patient relationship.
My message during this webinar was the same as it was throughout my 18-year tenure as CEO of The Permanente Medical Group: We must elevate the status of primary care and broaden our support of this vital specialty. We must do so not because it’s the kind or compassionate thing to do, but because it is what’s best for patients and for the health outcomes of our nation.
Consider the results of a Harvard-Stanford collaborative research study published in 2019, which examined life expectancy rates in the United States over the course of a decade. The team found that adding 10 primary care physicians to a population of 100,000 people is associated with an average life-expectancy increase of 51.5 days. That’s compared to a 19.2-day increase for an equal number of specialists. In other words, adding 10 primary care physicians has a 250% greater influence on life expectancy than an equivalent bump in specialists.
And yet, despite these facts, when a patient suffering from a heart attack is brought back to life in the ED, the cardiologist who unclogs the artery is labeled a “hero.” There are kudos from colleagues and thank-you cards from grateful family members. The fee schedule validates the surgeon’s hero status, reinforcing the misperception that intervening during a crisis is more valuable than preventing one.
This flaw in the design of the healthcare system—reinforced by the cultural values of American medicine—leads our nation to overvalue the impact of doctors who operate on people and undervalue the physicians who keep patients off the operating table in the first place.
Today, the United States ranks first in the world in the proportion of specialists to generalists (and there’s not a close second). This imbalance contributes to another sad fact: The United States ranks dead last among high-income nations in measures like life expectancy, childhood mortality, maternal mortality and several other measures of healthcare quality.
In both of my books, “Mistreated” (2017) and “Uncaring” (2021), I lay out the blueprint for a healthcare system that features lower costs, higher quality and greater convenience for patients. Primary care is central to that design, just as it remains central to the nationally recognized care delivered to more than 5 million Kaiser Permanente members.
To learn more about importance of primary care, I urge readers to check out the Primary Care Collaborative (PCC), a not-for-profit organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home.
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Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits go to Doctors Without Borders.
