Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: The case for primary care

In spite of the debate, drama and widespread awareness of the health care agenda in America, there has been no progress in resolving the most fundamental problem. This problem is the lack of resources for primary care services.

The Affordable Care Act (ACA), poised for repeal, actually did take some positive steps in this direction, according to the New England Journal of Medicine in its Health Policy Report in 2015 (Blumenthal et al.). Relative quotations from this work include: “The ACA has had its clearest and most measurable effects to date on the availability of health insurance to the American people and on their access to care… All told, more than 30 million Americans now have insurance under these new sources of coverage and consumer protections.”

Although we clearly have more of our citizens with coverage, it is not clear that this translates to true primary care that focuses on health education, wellness and prevention of the common chronic medical problems of obesity, hypertension and diabetes. This problem is not so much related to health care coverage as it is to the emphasis on the treatment of disease and the lack of providers to deliver this type of care.

In an important paper published by the Association of American Medical Colleges in April 2016, the scope of this problem is revealed: “By 2025, the study estimates a shortfall of between 14,900 and 35,600 primary care physicians.”

The answer lies in broadening the base of providers that provide primary care services and moving more of the health care dollar into this critical aspect of care. Yet movements in this direction are always going to end up in legislative battles and will be fought by many physician groups in spite of the obvious shortfall in physician numbers. Even nurse practitioners trained specifically in primary care will have to fight this battle, as noted in the Health Affairs, Health Policy Brief, “Nurse practitioners and primary care.”

For optometry, legislative efforts in each state must consider the public health need for expanded primary care services vs. further expansion into surgical eye care and laser procedures. State legislative committees and active state association members must ask themselves this important question before setting the legislative agenda: “In the past month in practice, did I see more patients that were obese, pre-diabetic, diabetic or with hypertension or more patients that needed a laser procedure?” And given the volume of these patients, “Does my state have the physician manpower to meet these needs of these patients?”

For the schools and colleges of optometry, it is important to consider the role of your future graduates in the health care system. Given the technology of the new millennium to perform the routine eye examination and evaluate and treat ophthalmic pathology, can’t our students spend more time on the prevention, diagnosis and management of the systemic pathology that leads to low vision and blindness?