Dr. Jeffrey A. Linder’s Jan. 26 commentary, “An unhealthy trend” (Page D1), points out one of many problems with our current “health care system” in that primary care in the United States could be slowly dying out (citing a JAMA Internal Medicine study).

Primary care doctors serve as the “quarterback” for all the care you receive, coordinating all care efforts on their patient’s behalf. With that comes the satisfaction of truly getting to know the patient. Studies show these patients stay healthier, and that, in Linder’s words, “U.S. counties with more primary care doctors have lower mortality.” That means “fewer emergency department visits, hospitalizations and lower costs.” However, fewer physicians are choosing primary care practices because of lower reimbursement than for specialty practice and constraints on time to spend with patients to support a satisfying relationship.

Fortunately, in Maine, this issue was addressed by the Legislature in the early 1990s. Family nurse practitioners educated at the graduate level and board-certified to provide primary care to patients were given full practice authority to do so. “A 2014 Veterans Affairs Evidence Brief found no differences in the care of (nurse practitioners) compared with that of doctors in seven parameters,” a recent Medscape commentary noted.

The needs of many of the citizens of Maine for primary care, especially in rural areas, are met by nurse practitioners as well as physicians. U.S. health care dollars need to focus on prevention and wellness, reimbursing both nurse practitioners and physicians equally for this critical component to better balance the current illness-directed system.

Susan Davis Doughty, WHNP-BC


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