Recently the federal Centers for Disease Control and Prevention reported that the average wait to see a physician in the emergency room has increased 47 percent since 1997. Patients, many of whom are uninsured or underinsured, avoid seeing a primary care physician due to cost concerns. Instead, they often take primary care issues to an emergency room when they can no longer ignore their illness or injury.

In this election year, the availability of adequate health insurance and access to quality primary care must be priority issues. Primary care physicians -- those specializing in family practice or internal medicine -- are the foundation of a solid health-care program.

Using primary care physicians as the leaders of the health-care team improves patient health, lowers mortality rates and reduces medical costs. Primary care physicians save lives, prevent disease and ease suffering. They also help patients navigate our complicated health-care systems, direct their ongoing care, guide them to appropriate medical resources and keep them from undergoing unnecessary tests and services.

Research by Barbara Starfield of the Johns Hopkins University Bloomberg School of Public Health, and colleagues, shows that the United States, compared to other developed countries, ranks lowest in primary care-based functions and lowest in health-care outcomes, but highest in health-care spending.

They reviewed more than two decades of accumulated evidence that revealed having a primary-care based health system (as opposed to a specialist-driven system) provides both health and economic benefits. Countries with primary care-based health systems had lower all-cause mortality rates and reduced mortality caused by cardiovascular and pulmonary diseases; less use of emergency departments; better preventive care; better detection of breast cancer and reduced incidences and mortality by colon and cervical cancers.

In addition, the research indicated that primary care-centered health care results in fewer medical tests, higher patient satisfaction, less medication use, lower care-related costs and reduced health care disparities within a population. Other research by Starfield, et al., indicates that an increase of one primary care physician per 10,000 population is associated with a reduced overall mortality rate, regardless of area of analysis (county, state, metropolitan).

Unfortunately, we are experiencing a shortage of primary care physicians locally and nationwide. As many patients know, obtaining an appointment with a primary care physician is becoming increasingly difficult, even for those with health insurance coverage.

According to the American Medical Association and the National Resident Matching Program, fewer U.S. medical school seniors are choosing residency positions in family medicine, continuing a trend that began in 1997. Internal medicine and pediatrics residency matches also have been experiencing decreases in the past decade. The path from undergraduate studies to practicing physician is long and costly. Loans needed to attend a four-year medical school are in the six-figure range. Such personal and financial sacrifices lead many students to select a specialty that will compensate them at a higher rate.

As a result, fewer medical students are choosing to become primary care physicians. Those primary care physicians who remain are facing increased patient loads, especially as the patient population ages and requires more ongoing care. According to a 2007 study conducted by the Pennsylvania Medical Society, the age of the commonwealth's population will increase dramatically through 2030, at which time approximately 26 percent of Pennsylvania's population will be 62 or older, compared to 16 percent in 2007. Moreover, the physician population is aging as well, and as primary care physicians retire there are too few to replace them.

The shortage of primary care physicians especially affects those in rural areas, leaving these patients without a provider of routine health care. Because of the shortage of primary care physicians more patient care is being provided by what are known as "physician extenders." These professionals include physicians' assistants and certified nurse practitioners. Overall, nurse practitioners and physicians' assistants are very well trained and skilled, and, in fact, provide a great service in doctors' offices.

However, in a setting where a physician is not present to examine patients, there is a risk of inaccurate diagnosis or of missing a serious medical condition. Seemingly "simple" cases often are not really simple. Physicians spend many years studying and practicing medicine in order to discern whether an apparently "simple" symptom is indicative of a more significant problem. Primary care physicians are also trained to care for patients' chronic, ongoing medical conditions. Often patients have more than one chronic condition and primary care physicians must treat these complex conditions simultaneously.

We must preserve and expand the practice of primary care because it is the key to quality health care. These physicians provide a medical "home base" for patients. They use their expertise to evaluate conditions and determine the best courses of care. They discern the minor cases from serious problems and advise their patients accordingly. Creating and preserving the patient-physician relationship is significant in terms of continuity of care and establishing a designated hub for a patient's medical history.

If we allow primary care to erode, patient care will suffer. It is imperative that our nation's health-care discussion include plans to revitalize primary care medicine by valuing those physicians already in service and by making it a viable choice for medical students. Increasing the emphasis on primary care will benefit both patients and our complex health-care systems.