An Approach to Alleviating the Pain of the Primary Care Physician Shortage

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Photo credit: Depositphotos

By Sherry McAllister, DC, M.S. (Ed), CCSP

The numbers are grim. The U.S. could experience a shortage of up to 55,200 primary care physicians (PCPs) by 2033, according to data published in June 2020 by the Association of American Medical Colleges (AAMC). The shortage could be even higher considering the impact of the COVID-19 pandemic on PCPs’ plans for the future, which is causing about half of these physicians to reconsider their career plans.

Opportunities, however, exist to limit the shortage’s impact while ensuring that healthcare is widely accessible to Americans. A large and often untapped reserve of highly trained healthcare professionals are ready to step in to handle many of the common issues currently managed by PCPs: the nation’s more than 70,000 licensed doctors of chiropractic (DCs). Just as any other qualified healthcare provider, DCs are eager to help patients achieve the levels of health and wellness that keep them mobile and productive. 

The most common health complaints DCs manage are types of neuro-musculoskeletal pain, such as back, neck and joint pain and headaches. Joint and back pain are the second- and third-most common reasons for patients seeking care from a physician, according to a Mayo Clinic study of more than 142,000 individuals. Diverting some patients—your employees—to DCs instead of PCPs could reduce demand on those physicians while still offering effective, drug-free pain relief for your teams.

After all, chronic pain conditions have a significant impact on employers and the economy. Low back pain alone, for example, accounts for more than 264 million lost workdays each year, and more than $2.6 billion in healthcare costs annually. With lost wages and decreased productivity, the healthcare costs and economic losses attributable to chronic pain, especially back pain, jump to as much as $635 billion, according to the National Academy of Medicine.

Seeking a DC First

Encouraging employees to seek a DC first when experiencing neuro-musculoskeletal pain – essentially positioning DCs as the first choice for those issues – could help quickly alleviate the pain of the future PCP shortage by redirecting patients to the appropriate provider based on their health complaint. 

If employees access chiropractic care first, it could also significantly reduce the burden on currently practicing PCPs, enabling them to focus on other conditions and injuries, particularly those requiring surgery or pharmaceutical drugs. Chiropractic care uses no pharmaceutical drugs or surgery and DCs do not prescribe medications. 

Neuro-musculoskeletal pain takes on added urgency during the pandemic as practicing DCs say patient complaints about neck, back and related pain have increased with the rise of telework. Hunching over laptops in workspaces that are not designed for ergonomics or sitting in kitchen chairs rather than supportive office chairs contribute to spinal dysfunction over time.

The end of the pandemic does not necessarily guarantee a return to standard office spaces. Many Americans may continue working all or part of the time from home, which will further this trend beyond the pandemic. Positioning DCs as the primary choice for pain and mobility problems can help mitigate the impact on physician demand and employee healthcare costs.  

Supporting the Care Team

Another valuable contribution DCs can make is triaging patients to determine the appropriate level and care provider. DCs can record employee vital signs, such as temperature, pulse, height, weight and conduct interviews about their medical history and current health problems. They can then determine which complaints they can address themselves and which should be managed by other providers. 

In some cases that may still mean referring patients to an internist or family medicine physician. In others, however, they can refer the employee directly to the appropriate physician specialist, again relieving the patient load of overburdened PCPs. As electronic health records (EHRs) become more interoperable and easier for healthcare professionals (and patients) to access, this solution of accessing DCs as the point of entry to the healthcare system rather than a secondary therapy becomes even more viable. 

The ability to coordinate care in this way is one reason why many onsite employee health and wellness clinics have a DC on staff. According to results of a 2018 survey of employers, employees who received care in employer-based clinics with a DC or other physical medicine practitioner on staff showed greater mobility and functional status in eight visits fewer than community-based clinics, resulting in $472 to $630 savings per patient episode. Employees were also highly likely to recommend integrated employer-sponsored care.

Safe, Drug-Free Care

Repositioning DCs as the primary care provider for back, neck, joint and other neuro-musculoskeletal conditions offers another critical advantage/improvement in treatment: DCs are often the least-invasive, lowest-risk option for managing pain. 

If a PCP refers a patient with back or neck pain to a surgeon, the surgeon will likely prescribe medications, such as opioids, for acute pain relief and/or after surgery. There are multiple risks associated with these courses of treatment, not the least of which are the potential for an opioid-use disorder (whether or not surgery is performed), hospital-acquired infections, or a complication with the surgery itself. In employer-sponsored clinics that offered physical medicine, including chiropractic care, non-cancer patients received only one-tenth as many opioid prescriptions compared with community clinics (2.8% vs 20%).

A DC’s first care option for neck or back pain could be spinal manipulative therapy (SMT), commonly called a chiropractic adjustment, which involves using their hands and/or a tool to apply a specific, controlled force to a joint to restore proper function and mobility, as well as to support the nervous system. Perhaps the DC will recommend applying ice and/or heat to the painful area, as well as stretching and exercises. This path is safer, less intrusive into the patient’s life and less costly. Only after all non-surgical options have been exhausted would a DC consider referring that patient to a surgeon. Since the other options have already been tried, both patient and physician can enter the next phase knowing that surgery is the right course of action. 

The looming PCP shortage seems daunting, but with a more creative and resourceful approach and changing the perspective on healthcare as a team-based service instead of focusing on the physician alone, the looming crisis can quickly turn into a non-event. 

Doctors of chiropractic should be on that team. They are highly trained healthcare professionals who are available in large numbers to expand care access and to deliver the first point of entry into the healthcare system as primary care providers.  It is time we started depending on them this way. 

About the author:

Sherry McAllister, DC, is president of the Foundation for Chiropractic Progress (F4CP). A not-for-profit organization, the F4CP provides information and education regarding the value of chiropractic care and its role in drug-free pain management.

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