OP /ED
Until 2021, most Texans didn’t think twice about the state’s electrical grid. But that year, the grid widely failed when an Arctic snowstorm strained its capacity, leaving millions without electricity or heat for several days, wreaking havoc on the state. The collective shock of that experience drew Texans’ attention to the fact that the electrical grid needs regular maintenance, investment, and research and development to ensure it can keep pace with the state’s growing population and changing energy needs.
Like the electrical grid, Texas’ primary care system has struggled to keep pace with the needs of a modern state. Of the state’s 254 counties, 224 are designated as primary care health professional shortage areas. Is it any wonder that getting a primary care appointment can be a nightmare, even if you already have a primary care physician? In a state brimming with world class medical schools, health science centers, and hospitals, many Texans have been left scratching their heads, asking how the state’s primary care system got to this point.
We know a robust primary care “grid” is vital to Texas’ interests, serving as the bedrock of the state’s health care system. Numerous studies show that robust access to primary care benefits both individual patients and communities. Patients with a regular primary care relationship have better health outcomes, higher satisfaction, and lower overall health care costs, while communities with higher numbers of primary practices enjoy better and more equitable population health, making primary care a common good — like electricity.
Nationally, primary care practices provide more than one in three health care visits and often serve as the only source of care for patients, including people with chronic conditions, such as diabetes, or mental health needs. For underserved communities, primary care often is the only option.
Increasing the number of primary care physicians practicing in Texas is the first step to fixing this problem, and it’s a step Texas has taken. Over the past several legislative sessions, lawmakers have allocated significant funds to expand graduate medical education, grow rural primary care training programs, increase access to primary care loan repayment, incubate new federally qualified health centers, and more.
However, expanding the primary care workforce without better understanding how to optimize the practice of primary care, its integration into the larger health care system, and its ability to adapt to a rapidly growing population is like installing more power lines without knowing if they’re going to the right place or can handle the load. Texas should now pair investments in its primary care workforce with research into how to improve its efficacy and ingenuity, developing strategies to improve patient management, health outcomes, and interprofessional collaboration. In other words, Texas must help primary care practices adapt now so they will be available in the future.
Research dollars dedicated to primary care account for only 0.3% of all federal research funding. Texas similarly spends little to no dollars specifically on primary care practice improvement. As a result, primary care clinicians are reliant upon research conducted in settings unlike theirs or among patient populations that do not directly correspond to primary care.
According to the National Academy of Science, Engineering and Medicine, “The neglect of basic primary care research … not only adversely affects primary care outcomes but also leads to the lack of a population-based understanding of illness and disease along the health care spectrum. Better [primary care research] support could lead to answers to questions that are critically important for improving population health.”
Texas can solve this deficiency by establishing and funding its own Primary Care Research and Innovation Lab, in partnership with the state’s health science centers, with the express purpose of evaluating strategies to improve primary care resiliency, capacity, access, efficacy, cost effectiveness, and interprofessional, primary care collaboration.
As the state’s primary care system goes, so goes the rest of the health care system. Texas has long incubated state-of-the-art medical and specialty services, such as cancer research to improve cancer treatment, with the goal of improving the health of its own residents as well as the nation. That expertise now should be harnessed to research and reimagine a sustainable, resilient, integrated, cost-effective, and accessible primary care model that can power Texas’ health care system.
