Before discussing the value of generalists, it’s important to recognize the continued importance of specialists in healthcare. Having certified, focused expertise in the area where help is needed is compelling to patients. Specialists represent almost two-thirds of the practicing physicians in the U.S., and these numbers place us 11th out of 28 countries based on availability, with some of the most frequently requested specialties listed as psychiatry, internal medicine and obstetrics / gynecology.
But the leading provider requested in 2017 and for the past 20 years is family medicine. Unfortunately, the U.S. ranked 24th out of 28 countries in providing primary care. The evolving demographics and concerns of patients in the U.S. point toward an increasing need for generalists. Understanding the value of generalists in healthcare can help recruiting teams and healthcare organizations align with this trend.
Dynamics Driving Need for Generalists
In the last 50 years, medical school emphasis shifted toward specialization. Specialties attract research and reimbursement dollars, and specialists remain highly valued by medical institutions. Interest in generalists reflects a landscape altered by changes in patient profiles and healthcare services, along with a recognition that despite these shifts, the fundamental needs of patients remain the same. Hippocrates’ counsel from more than two centuries ago – “it’s more important to know the patient who has the disease that the disease the patient has” – summarizes the philosophy underpinning this refocus on generalists.
Changing Patient Profiles
Aging, More Diverse Population. In the U.S., residents at least 65 years old represent 15.2 percent of the population, doubling in size in the last five decades. This growth has been driven by the aging baby boomer population. Those born after World War II accounted for about 22% of the population in 2017, and as they continue to age, the U.S. will have an older patient profile. It’s not just the boomers’ shift into senior status boosting the median age. Since the beginning of the 21st century, U.S. life expectancy has increased by two years to 78. This aging population requires generalist knowledge of multiple geriatric issues and palliative care.
The U.S. patient population is also becoming more diverse with 21 states estimated to have non-white majorities by 2050. A more ethnically diverse audience brings a new mix of health conditions, sometimes tied to the country of origin. Culture differences will also affect patient needs, requiring community-based understanding of traditions, religions, and languages.
Increased Incidence of Multiple Chronic Conditions. About 25% of U.S. patients had multiple chronic conditions (MCC) last year, up from 21% in 2005. Among the elderly, the increase is more substantial, shifting from 62% in 2005 to 75% last year. Shuttling from specialist to specialist is challenging for any patient, but can be more difficult for seniors.
Changing Healthcare Services
Patients Seeking Comprehensive Healthcare. The needs of a population that is aging, more diverse and with multiple chronic conditions has fostered an interest in physicians who can provide whole-person support. These groups may favor a generalist who isn’t limited to treating specific conditions or using certain methods of treatment, and who can be the point person for specialists.
Rising Healthcare Costs Point Toward Prevention. Younger audiences, like millennials, view healthcare differently than other generations, in part because of the cost. Staying healthy through diet, fitness, and life balance, and avoiding the costs associated with illness is an essential component of healthcare for these patients. Working collaboratively with a physician who can counsel about prevention across the whole body addresses a key need for younger patients.
Opportunities for Generalists
The need for generalist physicians in the U.S. is large and growing. Generalists offer a unique and relevant set of skills to address any problem presented to them, including those with psychological or social causes. Their expertise isn’t defined by an organ system or procedure, but rather by their ability to assess and deliver whole-patient treatment, in collaboration with the patient and with specialists. Generalist primary care has been shown to deliver better prevention and reduced healthcare costs. Equally important is generalists’ contribution to a better patient experience, developing relationships, following through and making a difference.
The value of generalists in healthcare is indisputable. Making sure your team includes generalists will enhance your practice and your patients’ experiences.
