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Fraser Cobbe

Orange County Medical Society

Seminole County Medical Society

There are a number of media reports this week that further illustrate the drastic shift in utilization of primary care services by Millennial's away from the traditional physician-patient relationship. With any disruption in traditional markets there are always winners and losers, and while there are obvious concerns for primary care physicians with this drastic shift in utilization, the long term impact may be felt more severely by those that provide health insurance coverage, notably business and government.

An article that appeared in Kaiser Health News provided the results of a poll of 1,200 adults conducted by the Kaiser Family Foundation that found "45 percent of 18- to 29-year-olds had no primary care provider, compared with 28 percent of those 30 to 49, 18 percent of those 50 to 64 and 12 percent age 65 and older."

Solv further expanded upon this shift, citing a survey conducted by PNC Healthcare that found that Millennials make up 25% of the patients seen at urgent care centers -- that's about twice as many as Baby Boomer patients (17%).

It has long been understood that Millennials, being more conditioned to convenience and immediate access to information and results, are turning towards urgent care centers, retail clinics, and telemedicine. The data reported this week shows that the shift in utilization continues to accelerate. Physicians would be wise to pay attention to the trends and take advantage of opportunities to meet this growing demand.

But what is the long term impact of Millennials turning their collective backs on decades of science and advocacy that espouse the benefits of continuity of care and the importance of the medical home?

The increased cost of unmanaged or mismanaged chronic disease is well documented. And there is growing evidence that care rendered in the urgent care or retail clinic space can further fragment care and increase costs due to a lack of history and inappropriate utilization of services.

The Washington Post covered a recent report in JAMA Internal Medicine that "found that nearly half of patients who sought treatment at an urgent care clinic for a cold, the flu or a similar respiratory ailment left with an unnecessary and potentially harmful prescription for antibiotics, compared with 17 percent of those seen in a doctor's office. Antibiotics are useless against viruses and may expose patients to severe side effects with just a single dose."

This potential wave of increased cost has not been fully recognized as of yet as this generation of patients is still in a period of their lifespan where average health care spending is very low comparatively. As Millennials, commonly defined as those born between 1981 and 1996, strive into their 40's where utilization starts to trend upward significantly, the impact on health care costs and those that purchase health care coverage, could be right on the horizon.