Addressing the Primary Physician Shortage and Ensuring Equitable Sickle Cell Care in the U.S.

Addressing the Primary Physician Shortage and Ensuring Equitable Sickle Cell Care in the U.S.

Introduction:

The United States is facing a potentially debilitating shortage of primary care physicians, with estimates ranging from 14,900 to 48,000 by 2025 to 2034. Simultaneously, the development of gene therapy for sickle cell disease (SCD) brings hope for a cure. However, it is crucial to approach this milestone with caution and address the underlying issues of healthcare access and social justice. In this article, we will explore the connection between the primary physician shortage and equitable sickle cell care, and propose actionable solutions to ensure high-quality care for all.

The Need for Comprehensive Care Networks:

To provide equitable care for individuals with SCD, comprehensive care networks must be established. These networks should encompass both clinical and non-clinical elements to deliver just and quality care. Clinical components involve preventing, identifying, and treating acute and chronic complications of the disease. Key players should include primary care physicians, multidisciplinary specialty care providers, and behavioral and social health professionals. On the other hand, non-clinical elements aim to evaluate, identify, and provide support services that ensure SCD patients lead longer, quality, and productive lives. Optimal access to eligible social services, including disability benefits, health insurance, education, talent development, and reproductive needs, should be prioritized.

Evaluating Care Delivery and Outcomes:

To monitor and improve care delivery, specific indicators should be considered. These include general and disease-specific risk screenings, preventive interventions such as vaccinations and prophylactics, evidence-based treatment of acute and chronic complications, care coordination, transitional services for successful pediatric to adult care transition, and access to social and mental health services. Additionally, data collection, integrity, and interoperability are essential for evaluating geographical access, care/service utility, and outcomes.

Leveraging Scientific Advances for Social Justice:

While gene therapies offer hope for a cure, they do not address the social problem associated with SCD care. It is crucial to leverage this scientific moment to address both the genetic and social aspects of the disease. The historical context of racism and racialized healthcare systems must be acknowledged and rectified. Moreover, the high cost of gene therapy must be considered in comparison to the lifetime cost of care for SCD. From the perspective of insurers and the tax-paying public, gene therapy is a worthwhile investment. However, this calls for a reevaluation of value-based care models that fail to provide just and equitable care. A loss-framed behavioral economic model could offer a potential solution to this complex issue.

Actionable Advice:

• 1. Advocate for the establishment of comprehensive care networks for SCD that encompass both clinical and non-clinical elements to ensure equitable and just care for all individuals.

• 2. Push for the implementation of specific indicators to evaluate care delivery and outcomes, including screenings, preventive interventions, evidence-based treatments, and access to support services.

• 3. Engage in discussions and research on alternative care models, such as the loss-framed behavioral economic model, to address the high cost and lack of equity in healthcare delivery.

Conclusion:

As the primary physician shortage looms and gene therapy offers hope for individuals with sickle cell disease, it is crucial to address the underlying issues of healthcare access and social justice. By establishing comprehensive care networks, evaluating care delivery and outcomes, and leveraging scientific advances for social justice, we can ensure equitable and high-quality care for all. It is our responsibility to advocate for change and work towards a healthcare system that truly serves the needs of every individual, regardless of their socioeconomic background or geographic location.