Trends in Primary Care 2020
Sometime around March or April 2020, I was so intrigued about this show called, “Tiger King”. I like animals but I never thought that I would binge-watch it the way that I did. Yes, judge me all you want but I finished all the episodes in one day. I could have finished my NP CME hours instead of sitting in my comfortable couch that day, I know. But I just had to do it! It was the hot topic everywhere and yes it was very interesting. Another trend today is the Tik-Tok app which people use post short videos of themselves. There is this craze where people are eating a jalapeño with cream cheese and Takis chips inside. I love jalapeños so yes, I tried it and it tasted good.
Most of us are aware of trends in this era and as humans, we all thrive through changes. Plainly, that is how we all evolve.
On a more serious note, I have also noticed variations at my current career specialty, Primary Care. I reckon that it is paramount for me, as a Nurse Practitioner, to understand and be aware of these. It has helped me adapt, function, and collaborate better. There are quite a few trends in Primary Care/Family Practice, but I will mention the following recognizable ones:
There is a stable increase in demand for Midlevel Practitioners nationwide. Advanced practice providers (APPs) pertain to Nurse Practitioners/Nurse Anesthetists/Nurse Midwives and Physician Assistants who are non-physician professionals and are comprehensively trained to become physician “extenders”. The U. S News ranked the CRNAs, NPs, and PAs as some of the best jobs in America in 2020. This link should show the data: https://money.usnews.com/money/careers/slideshows/the-25-best-jobs?slide=27
APPs are known to be of huge support in filling in the gaps of healthcare by attending to the physician shortage especially in the rural areas. Primary care physicians are well known to have been in shortage for countless years. For example, my most current employer just had 2 physicians resign, hence, urging them to hire more APPs. They could not find physicians to replace the ones who just left. In my opinion, this is also contributing to more profitable business for employers since APPs are paid lesser than the physicians. Undeniably, this change is most likely here to stay. There will always be people needing healthcare and until there are enough physicians to meet the supply and demand chain, APPs will continue serving the populations.
Telehealth is now the new Healthcare Fast-Food Delivery system. You read that correctly, consumerism has been paramount to the satisfaction of the people of America and yes, COVID-19 has deliberately contributed to that as well. When I was still an NP student about 4 years ago, I did not recall witnessing a patient talking to a doctor/APP through the phone or Facetime/Zoom for a visit. To my understanding, it took days, weeks, or worse, months to even book an appointment to see a Primary Care provider. Nowadays, especially due to the pandemic, patients rely on technology to “visit” their health providers to help them resolve their health issues. I usually have half of my patients for the day as medical phone visits. I think that nothing is better than the interpersonal connection and the physical assessment that occurs when patients visit the clinics for their health checks. However, with this time of uncertainty, I think that this is still the best way to go for some sick or concerned patients needing care. I doubt that this practice is being phased out soon. Restrictions have been placed and unfortunately, fear has also been instilled into some that inhibit them from even going out for health appointments. For the healthcare providers, I believe that this is a great option of career especially for those who have family or small children that they also have to care for at home during this coronavirus season.
Incidence of depression and anxiety among patients have been noticeable. My most current experience has been working as an NP in an FQHC, therefore, we care for a huge population of the underserved and mental illness has been prevalent. However, the pandemic has caused the rise in this statistic as well. The stress from being alone, loss of community contact, disease, fear, income loss, dysfunctional relationships, and a plethora of reasons have contributed to more threat to the population’s mental health. Unfortunately, this will also likely be a common occurrence. More and more people will be needing assessment, treatment, and interventions for behavioral health.
Prescribing of narcotics can now be done through electronic charting. Sometime early last year, I still remember writing prescriptions for narcotics to my patients. First of all, let me be clear, I do not usually order narcotics, but I usually do when truly indicated. What appears quite convenient for me is that I do not even have to write the scripts now, I can simply order the medication on the patient’s electronic chart and after a few more steps, I am able to send the controlled substance straight to the patient’s pharmacy. Isn’t that amazing? This change will only develop further, providers will continue having the ability to use computers to render care to the patients.
Since the COVID-19, lockdown, the productivity for patient visits have significantly decreased. Sometime around December 2019, I remember almost feeling burnt out for seeing about 25 patients daily during my 8-hour shift, and then closing my charts thereafter. It was very laborious, but I was content to have a good amount of patient census. However, this has significantly been altered around March 2020 after the lockdown was announced. I started seeing less than 10 patients per day, sometimes even only 4 of them. Most patients who were due for preventative or physical exams have been cancelled, and only acute visits were scheduled. This also affected school physical exams since the children’s schools remained closed and doing health reports were not needed. Nevertheless, since the lockdown has been slowly lifted, more patients have been coming in for physical visits. People became more comfortable going in for their health checks. Lest this pandemic worsens or until there remains no improvement in our COVID-19 statistics, I think that this will only be temporary. I believe that the census for patient visits will soon be elevated, especially during the anticipated wintertime, when the flu season usually occur. This is only temporary.
Moreover, whether or not we like it, changes are inescapable. Whatever drifts come to our practice, we will all acclimate well, being the resilient and adaptable APPs that we are.
About the Author:
Tricia Alegado, FNP-C, CNOR
Tricia has been an APPAA contributor since 2020. She has over 15 years of experience as a registered nurse and 2 years of experience as a nurse practitioner.