Graham Center Policy One-Pagers

These reports offer succinct summaries of research and perspectives pertinent to family practice advocacy and are produced by the Robert Graham Center: Policy Studies in Family Medicine and Primary Care in Washington, DC.

Dec 1, 2014 Issue
Accounting for Complexity: Aligning Current Payment Models with the Breadth of Care by Different Specialties
Family physicians provide care for a wider range of conditions than do most specialists, introducing a high level of complexity into their practice. Historic assumptions associating complexity with the intensity, skill, and training required to accommodate a single task fail to capture the complexity of identifying and managing many interacting conditions. Payers and policy makers should recognize this dimension of complexity in care and revisit payment criteria.

Aug 15, 2014 Issue
The Continued Importance of Small Practices in the Primary Care Landscape
In 2010, as many as 45% of active primary care physicians (PCPs) were practicing at sites with five or fewer physicians. This large cohort of practices faces unique challenges in meeting the increasing demands of practice transformation, payer reporting requirements, and integrated delivery that merit policy maker and payer attention.

Jul 15, 2014 Issue
Family Medicine Residents: Increasingly Diverse, but Lagging Behind Underrepresented Minority Population Trends
Increasing racial and ethnic diversity in the U.S. population has not been fully realized in the physician workforce. Family physicians, the most widely distributed of the physician specialties, are on the front line of a physician trend toward greater racial and ethnic diversity over the past two decades, but residents still lag behind national growth in the underrepresented minority population.

Jun 1, 2014 Issue
Winnable Battles: Family Physicians Play an Essential Role In Addressing Tobacco Use and Obesity
Tobacco use and obesity are linked to most deaths and significant disability in the United States, and family physicians are uniquely positioned to address these issues. This highlights a need for transforming primary care practices and teams to systematize the recognition and management of unhealthy behaviors, and for alternative payment models that support these efforts.

May 1, 2014 Issue
The Changing Landscape of Primary Care HPSAs and the Influence on Practice Location
Health professional shortage area (HPSA) designations were created to highlight areas of primary care shortage and direct incentives to physicians willing to practice in these areas. We demonstrate the volatility of these geographies by examining the HPSA status of primary care physicians whose practice locations were the same in 2008 and 2013. Although the change in the percentage of physicians practicing in HPSAs over this period was negligible, approximately 28% of the stationary physicians lost a primary care HPSA designation, whereas about 21% gained a designation.

Apr 1, 2014 Issue
Projected Impact of the Primary Care Residency Expansion Program Using Historical Trends in Graduate Placement
The Primary Care Residency Expansion (PCRE) program was created by the Health Resources and Services Administration in 2010 to help address the shortage of primary care physicians. If historical graduate placement trends for funded programs remain stable, the PCRE program would have a potential impact of more than 600 new physicians working in primary care.

Feb 1, 2014 Issue
Ecology of Health Care: The Need to Address Low Utilization in American Indians/Alaska Natives
Disparities in health and access to health care continue to persist among the American Indian/Alaska Native population, despite federal efforts to call attention to and address these disparities.1 Policy makers should direct resources to ensure that this population has sufficient access to primary care services and motivation to use those services, which are important factors in the struggle to reduce disparities.

Nov 15, 2013 Issue
Migration After Family Medicine Residency: 56% of Graduates Practice Within 100 Miles of Training
With state planners working to address primary care shortages and federal graduate medical education payment reform looming, regional retention statistics for family medicine residency programs are a subject of high interest. Using the 2009 American Medical Association Physician Masterfile, we found that 56% of family medicine residents stay within 100 miles of where they graduate from residency.

Oct 1, 2013 Issue
Historic Growth Rates Vary Widely Across the Primary Care Physician Disciplines
Nested within a 40-year trend of specialty-to-population growth outpacing that of primary care is variability in the rate of expansion within the different primary care disciplines. With continued population aging trends, low annual birth rate, and expected health insurance expansion, it is vital that physician workforce policy be aimed at meeting population needs to deliver optimal primary care.

Aug 15, 2013 Issue
Relying on NPs and PAs Does Not Avoid the Need for Policy Solutions for Primary Care
Physician assistants (PAs) and nurse practitioners (NPs) are often proposed as solutions to the looming shortage of primary care physicians. However, a large and growing number of PAs and NPs now work outside of primary care, which suggests that innovative policy solutions to increase access to primary care are still needed.

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