By Dr. Marc Babitz
And the fourth access barrier to care I like to call availability. It means two things; one is really it's of a practical thing is when can you get care? Now this is a tough one because I'm a physician and do I want to work 24-7? Well no I don't. In fact I like working 8 to 6 or 9 to 5 or whatever it is--usually it's 7 to 7, but I like those hours, and most doctors do the same. But people don't get sick between 8 and 5. They get sick at nighttime or on weekends, so what do we do then? Is regular health care available at those times? Well, what we know is, often regular care with your provider is not available at those times, so what we do is we resort to things like emergency rooms or urgent care centers. I'm thankful they're there. Thank goodness we have that option, but those are expensive systems of care, they don't provide continuity of care. Those systems may not have my medical records or my patient's records when they see them, and those become problems in the health care system--they reduce the quality of care. So availability is an issue of when we can get care.
The other availability issue is the kinds of physicians and health care providers and the number of health care providers that we have. I know mostly about physicians, so I'll talk about that. Within physicians we know that 70% of our doctors are in sub-specialties, and only 30% of our physicians are specializing in primary care fields--primary being family medicine, pediatrics, internal medicine, and to some degree obstetrics and gynecology. Well national or international studies actually have shown that the ideal mix of physicians is about half and half; half in the sub-specialties, half in primary care, and we know there is a significant barrier to the availability of a primary care physician for those who need we call a ‘medical home’, or that kind of care, so that becomes a barrier to care. When a patient has to self-refer--when a patient has to ask themselves whether my chest pain... gee is it my heart? Or maybe it's my lungs, or maybe it's my stomach, or maybe it's my ribcage. Well gosh, those are four different specialties. Which one do I go to? When a patient does that, it makes it inefficient and a poorer quality health care system as opposed to a patient being able to go to their primary care doctor who can help sort that out, probably take care of it, and if not, refer them to the right source of care. So to me there are four clearly distinct access barriers, each one being very important as a part of the problem that we're dealing with.