Experts are calling for an infusion of about 10,000 primary care physicians into medically underserved areas over the next several years, even as medical students’ interest in primary care has waned.
The nation’s community health center, which serves rural and other medically underserved communities are facing a shortage of primary care providers, according to a report from the National Association of Community Health Centers, the American Academy of Family in George Washington University.
To expand services to nearly 30 million people by 2015, community health centers will need at least 15,585 additional primary care providers, including nearly 10,000 physicians, as well as nurse practitioners, certified nurse midwives, and physicians’ assistants.
The report, “Access Transformed: Building a Primary Care Workforce for the 21st Century”, concludes that policy makers need to get more medical students interested in primary care and ensure that newly trained go to work in medically underserved areas.
One solution offered in the report is to expand the National Health Service Corps program, which places primary care providers in federally designated Health Professional Shortage Areas. Through the program, physicians and other providers receive scholarships or loan repayment help in exchange for service in a medically underserved area.
Dr. G. W received a National Health Service Corp. scholarship more than 25 years ago and still works in the small Louisiana bayou town where he settled after training. “It is extremely gratifying” said an internist at the Teche Action Clinic, L.A.
He has experienced the shortage of primary care providers firsthand. Since he’s been there, the organization has never had a full complement of providers across its four clinics. Attempt to recruit an internist and a family physician for the past 2 years have been unsuccessful.
For physicians who practice in underserved areas, the rewards can be great. Patients hold you in high esteem and are very grateful for the care they receive, he said. “You don’t just treat them,” he said. “You worship with them and shop with them.”
The National Health Service Corp. is a model that works but has not received enough funding to support all of the qualified applicants.
Retention in the program is high, in fiscal year 2006, 76 percent of participating clinicians stayed in their positions for at least a year after their service commitments were fulfilled. But funding for the program has declined in recent years. In FY 2004, the program’s funding peaked at 169.9 million, and in FY 2008 it had fallen to 123.5 million, according to the report.
The report also urges policy makers to find a way to “revitalize” the J-1 Visa Waiver program, which has placed fewer foreign nationals into shortage areas in recent years. Foreign nationals who have received a US visa for educational purposes can opt out of going back to their home countries in exchange for practicing in a Health Professional Shortage Area.
The report also calls on Congress to revise the way graduate medical education is funded to make it financially viable for residency training programs to partner with community health centers.
Even without a formal blessing from Congress, some programs are finding ways to give residents experience in community health clinics. For example, Riverstone Health, a community health center organization in Billings, Mont., operates the Montana Family Medicine Residency training program. The center established the program in 1995 along with two local hospitals. The program is funded through clinic revenues, graduate medical education funds that are passed through the two hospitals, and some state assistance.
The program includes 18 residents and receives applications from many more students than it can accommodate. About 70 percent of the graduates have stayed on to practice in Montana.
Local residency program at a community health center is a natural fit because the traditional role of residency training programs is to care for underserved populations just like in community health centers.
Physicians payment is another area in need of reform, according to the report. The disparity in reimbursement between procedure-related specialties and primary care needs to be addressed to help attract more students to the field.
A family physician in Austin, Tex., sees the impact of the payment disparities when recruiting new physicians to the large, multispecialty clinic where he works. Medical students see low primary care reimbursement and declining Medicare reimbursement. Unless federal policy makers figure out a way to shift dollars to increase reimbursement for primary care, residency fill rates will continue to drop.
Officials at the American College of Physicians have been working with members of the House and Senate to craft comprehensive legislation that would address workforce issues and mandate higher reimbursement for primary care under Medicare. Among the proposals being discussed for inclusion in the legislation are plans to offer scholarships to medical students who serve in “high-need” facilities that are experiencing shortages or are having trouble recruiting physicians, and to provide loan repayment assistance during residency in exchange for a service commitment in these facilities.
ACP officials expect the legislation to be introduced this fall and are hoping that the ideas in it will influence health care reform proposals next year. –Charles C. Chante, MD (The Philippine Star)
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