July 3, 2024

The Albany Times-Union Commentary: In New York’s rural counties, primary care doctors are in short supply

To improve access to primary care, including pediatrics, we have to invest in it. State lawmakers missed an opportunity to do so this session.

Originally posted in The Albany Times-Union on July 3, 2024.

As New York’s beautiful summer season unfolds, parents of young children across the state are filling the parks and playgrounds. Between pushing swings and handing out snacks, you can guarantee one topic will come up among the parents: “Who is your child’s doctor? Have you found a doctor for a pre-school check-up?”

Unfortunately, for many families in rural New York, the answer will be, “No, we can’t get an appointment anywhere!”

Every child needs ongoing access to primary care to ensure their long-term health and development. In fact, primary care at all ages saves lives, leads to better health for communities and individuals, and helps address our nation’s significant health inequities. Primary care also saves money, both for families themselves and for the government, because investing in preventive and primary care up front keeps people out of the hospital and prevents them from needing more complicated, expensive care for serious health conditions. When children have regular access to primary care, there are significant lifelong benefits, including a greater chance of completing college and being healthier as an adult.

Consistency also matters: When a child sees the same person for their health visits throughout their childhood, they feel more comfortable with their provider, leading to greater trust and likelihood of seeking care. The provider is also familiar with their health and history and can more quickly diagnose new or unusual issues when they arise.

But many parents in New York cannot find a usual source of primary care for their children or themselves.

The Primary Care Development Corporation recently released the New York State Primary Care Scorecard assessing the state of primary care in New York. According to PCDC, rural counties in New York have less than half the supply of pediatricians than urban counties (64 pediatricians per 100,000 residents ages 0-17, versus 131 per 100,000). That shortage is likely linked to another serious problem: Across the state, 40% of 2-year-olds have not received their recommended vaccines.

If we know primary care is such a critical piece of the health care puzzle, why do so many parents have such a hard time finding it? Because primary care is undervalued and woefully underfunded. We don’t pay primary care providers enough to make it a sustainable career option, and we don’t have sufficient infrastructure to deliver care when and how people need it.

To improve access to primary care, including pediatrics, for every community, we have to invest in it. In fact, a number of other states have already started rebalancing their health care spending towards primary care, including Connecticut, Delaware, Oregon, Rhode Island and Washington. The federal government also has started to push states to invest more in primary care, releasing two new programs in the past year to encourage states to do just that.

The state Legislature had the opportunity to shift resources towards primary care this session with the Primary Care Investment Act (A8592/S1197B), which would have required health insurers to measure what they spend on primary care and increase it to 12.5% of their total health care spending over time. However, it has not yet passed. Going forward, state policymakers should commit to ensuring that at least 12.5% of all health spending, including new resources and pots of money like a proposed tax on managed-care organizations, goes to primary care.

The next time you’re on a playground with your kids, let’s hope we all have a better answer to that question, “So, who’s your child’s doctor?”

Jeffrey Kaczorowski is the chair of the New York chapter of the American Academy of Pediatrics. Laura Jean Shipley is medical director for maternal child health at Accountable Health Partners in Rochester. Cynthia Summers is managing director of the Primary Care Development Corporation. 

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