The Impossible Dream

People go into medicine to make a difference in people’s lives, and for primary care providers, that means prevention. Once in a while, we make a diagnosis or deliver a treatment that has real impact, but much of our care involves closing the barn door after at least some of the ponies have left. When it comes to really extending people’s healthy lives, prevention is the name of the game.

The USPSTF recommendations have been a godsend as far as defining the evidence-based practices that really prevent disease, but they’ve also been a burden. The number and scope of those recommendations increases every year. 

A 2021 article in the American Journal of Public Health estimated that the amount of provider time needed to follow all the USPSTF recommendations is 8.6 hours per working day, accounting for 131% of available provider time. In our current environment, comprehensive preventive medicine is literally impossible.

As a country, and in healthcare systems across the nation, we have a decision to make. Are we going to hire enough professionals to close this gap, or are we going to let people sicken and die from preventable conditions?

In fee-for-service reimbursement systems, where prevention produces little or no revenue, that additional person-power would be very expensive. Under capitated reimbursement, we could afford to use a whole team of caregivers who are less expensive than physicians, but it still wouldn’t be cheap. The bottom line is this: it will take more people and more money than we’re currently investing to keep people healthy. We know how to do this. It’s just a question of how badly we want it.