Everyone knows this old saw and the implication is that keeping away from a doctor implies that you are healthy. I like the message that healthy eating and living translates to better health, and in fact one of my favorite cartoons depicts a man sitting on his doorstep happily eating an apple with three men in white coats lurking off in the distance with the caption “An apple every 8 hours keeps three doctors away”. It slays me every time. But as you might intuit, not seeing a doctor (or other health care provider) may not be so good for your health.
Just last month JAMA Internal Medicine published a study by Basu et al, which looked at the impact of having doctors available to see patients and the results were eye opening. They studied outcomes in 3124 counties across the US from 2005 to 20015 and without getting into the details of their methodology, here is what they found:
- In those 10 years the number of physicians in those counties increased from 196,014 to 204,419, but the population at large grew faster.
Primary care physicians (e.g. family doctors, internists and pediatricians) decreased from 46.6/100,000 people to 41.4, with greater losses in more rural areas.
- For every 10 additional primary care physicians/100,000 people life expectancy in that population increased by 51.5 days, but only by 19.2 days for every specialist 10 specialists/100,000 people.
- Increasing the number of primary care physicians had the most positive impact on mortality (death) from cardiovascular disease, cancer and lung diseases.
It makes sense that cardiovascular disease, cancer, and respiratory illness are most sensitive to the presence or absence of primary care. Those illnesses are especially responsive to careful management with nimble responses to flare ups, and cancers can be impacted by reliable, evidence based screening, all of which is most impactfully provided through primary care.
This kind of data should compel our policy makers to work to enhance primary care and its availability in our rural states like Maine, which has experienced an overall drop in life expectancy in the last 15 years. CMS has comprehensive primary care initiative aimed at this, robust loan repayment programs and financial and tax incentives to attract health professionals to rural areas would help, states could invest much more in supporting primary care and our health care delivery system must change to value primary care at a level commensurate with its importance. A recent issue of the Journal of Ambulatory Care Management includes an important article on sustaining access to healthcare in rural areas, and PCHC’s CEO, Lori Dwyer and I have a companion opinion piece. I’ll be discussing both in a future Noah’s Notes.