As a specialty that manages complex chronic conditions and preventive care, primary care has been shown to reduce cardiovascular, cancer, and respiratory mortality and extend the lives of patients. Yet the field of primary care faces an unmanageable physician workload, lower average salaries than most other medical specialties, and medical students increasingly choosing other fields of medicine.

“Primary care is important to the country, but in many ways has been relatively invisible,” said Ishani Ganguli, MD, MPH, assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital Division of General Internal Medicine and primary care physician at BWH Advanced Primary Care Associates. “We’ve noticed the absence of a unifying voice for primary care that would have the ability to make an impact in Washington D.C.”

The National Academies of Sciences, Engineering, and Medicine (NASEM) Standing Committee on Primary Care aims to change that. On Nov. 6, 2023, the newly formed committee held its first public meeting with the mission to “serve as a focal point for discussions on priorities in primary care policy to inform [U.S. Department of Health and Human Service’s] initiative on primary health care” according to the group’s website. The Standing Committee on Primary Care is made up of 18 professionals, including Bitton and Ganguli. Committee members from across the country bring together their diverse backgrounds 2-4 times a year in meetings that are open to the public.

The NASEM Standing Committee on Primary Care

The Standing Committee on Primary Care is 27 years in the making. In 1996, the then-titled Institute of Internal Medicine (now named National Academies of Sciences, Engineering, and Medicine; NASEM) released a report titled Primary Care: America’s Health in a New Era with sweeping recommendations to improve primary care and the infrastructure that supports it. Over twenty years later, these recommendation had not been implemented, and in 2021 NASEM released the Implementing High-Quality Primary Care report to provide longitudinal guidance and practical steps forward in the face of worsening issues of burnout, patient access, and health equity.

“The 2021 NASEM report is a clear calling card around what the value of primary care is, what needs to change in order to achieve that value, and how we need to monitor and advise on the iterative improvements it needs across the U.S.,” said Bitton.

The report includes five implementation recommendations along with a three-prong implementation plan, including “an accountability framework that establishes a structure and process for assessing the adequacy and completeness of implementation activities.”

In addition to the creation of the standing committee, accountability has come in the form of publicly-available reports and scorecards, including a Massachusetts primary care scorecard from the state and a U.S. primary care joint scorecard created by Milbank Memorial Fund, Robert Graham Center, and The Physicians Foundation.

Creating pragmatic hope

Life expectancy in the United States continues to decline and social determinants of health exacerbate health disparities faced by patients in racial minority groups; people living in rural areas and those who live in urban areas; residents of different states; and people living in poverty compared to those who earn middle and upper incomes. “Improving equity is an intrinsic part of improving primary care—if we aren't doing that, we aren't doing it right,” said Ganguli.

Many clinicians agree that sweeping policy reform is needed and are looking to value-based care, increased investment, and updated technology as parts of the solution.

“If primary care was functioning at its full capacity, I would go into my clinic session being able to truly focus on my patients, whether that’s having tough conversations or performing procedures. Then I could quickly document the visit.” said Ganguli.

Physicians spend an estimated 3.2 hours per day on documentation and inbox management. According to a 2019 national study, office-based physicians spent a mean of 1.77 hours daily completing documentation outside of office hours. Epic, a common electronic health record software, found that even after making changes meant to reduce the documentation burden, the average length of clinical notes has continued to increase over the past three years. A team-based approach and updated technology could help alleviate this burden, allowing physicians to focus on a part of their jobs that brought them to medicine in the first place: patients.

“Cynicism is a luxury of the privileged in some ways, but the communities that we serve can’t afford that luxury,” said Bitton. “I think we need to move forward with pragmatic hope and optimism about what can and must be changed.”

To join in strengthening and saving primary care, you are invited to attend the next public NASEM Standing Committee on Primary Care meeting. To find upcoming meeting dates and register, visit the NASEM Standing Committee on Primary Care webpage. The webcast recording from the first open meeting held on November 6, 2023 is available here. 

**Feature photo obtained with a standard license on Shutterstock. The image has been altered to include a screenshot of the NASEM Standing Committee on Primary Care meeting that was held on June 6, 2023.

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