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This is a special series from the February 2023 issue of Desert Companion, where thought leaders share big ideas on how to improve Nevada's healthcare

David Weismiller: Make primary care more affordable

Dr. Weismiller works outside on his laptop
Illustration: Ryan Vellinga
Photo: Josh Hawkins for UNLV

Professor of Medicine in the Department of Family and Community Medicine at UNLV

Big Idea: Make primary care more affordable

Family physician David Weismiller has focused much of his career on education. In addition to being a professor at UNLV’s Kirk Kerkorian School of Medicine, he teaches continuing ed courses for physicians with the American Association of Family Physicians, the Emirates Family Medicine Society Scientific Congress, and other organizations. Through this work, he raises awareness of the cost and access barriers preventing effective patient care.

These ideas, Weismiller says, “aren’t very sexy. I mean, who wants to talk about this stuff ?” Still, he believes the most pressing issues facing healthcare in Nevada — and the U.S. in general — are its high prices and the difficulty finding primary care physicians.

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Typically, Weismiller explains, the more a community spends on healthcare, the more the life expectancy of its members goes up. This is true in most of the world’s developed nations, but not the United States. Among comparable countries, the U.S. has the highest cost of health care and very little to show for it.

The reasons are complex. Insurance in America is, by and large, linked with employment. Employers rarely invest in coverage for longer-term or chronic issues, because they won’t see the benefits of such investment during their employees’ tenure. This, in turn, leads to outsized costs for acute treatment down the road, and to highly preventable deaths.

At the same time, Weismiller explains, those without jobs or benefits simply can’t afford to see a primary care doctor. The leading causes of preventable disease and death in the U.S. include tobacco, excessive weight, and excessive alcohol use — all of which are best treated by a primary care physician. For instance, Nevada Medicaid covers a medication that reduces the risk of diabetes by 17 percent, but it won’t pay for you to see a registered dietitian to facilitate lifestyle modifications, which would halve the likelihood of getting diabetes.

This creates a cascading effect of costs and inefficiencies, whereby the burden of primary care falls on emergency room doctors and nurses, who are not trained to address these concerns. “They’re not talking to you about this in the emergency department,” Weismiller says. “‘Yes, you should quit smoking. But right now, we’ve got to deal with your heart attack.’”

Accessing primary care physicians is especially pressing for Nevada. We are, essentially, a rural state — aside from Washoe and Clark, no county has a population greater than 61,000. Investing more in well-distributed healthcare would go a long way toward addressing preventable illnesses and deaths throughout the state, Weismiller says.

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He has hope, despite healthcare problems being highly politicized in America. For him, as a doctor and as an educator, it begins with addressing the No. 1 complaint people have about doctors: “We don’t listen.” Weismiller begins his second-year lectures specifically telling students how to listen to patients.

This is essential, he contends, not just to more effectively treat patients, but also to build back trust with the public at large. “From there, we’re able to deal with all the other issues in a reasonable way." ✦