 Edwin Butler gets a routine exam from Murray West, M.D., at a community health center in Baltimore. The pipeline to keep family physicians coming to such centers is at risk (see "Contact Lawmakers Now: Funding to Train FPs in Jeopardy Again"). |
BY J. MICHAEL BRODIE
Edwin Butler lives in the urban neighborhood served by Belair-Edison Family Health Center. "This is where my doctor is," said Butler, who has come to the center for a routine checkup. "If my doctor wasn’t here, I’d have to spend a lot more money and make a choice between this and food and a roof over my head."
In the Baltimore Medical System -- comprising six community health centers, including the one Butler uses -- family physicians offer care and help keep the communities healthy. "Of the physicians in the system, we make up roughly a third," said FP James Corwin, M.D., of Baltimore, who runs several centers in the system. "Family practice has quite a voice here."
Every community health center wants the flexibility of an FP on staff, according to FP Murray West, M.D., Belair-Edison Family Health Center's medical director. "They don't want to hire a pediatrician because they know that if there is a time when there aren't a lot of (pediatric) patients to see, that person won't be productive," he said. "The main thing you lose (with other specialists) is integration. I see the kids, then I see the parents, and then I'll do the Gyn. For a family, there is more a sense of the whole being cared for" when the family sees an FP.
West, who has been at the Belair-Edison center nearly a decade, describes the center as a hybrid of family and geriatric practices that serves not only the growing uninsured population that lives nearby, but also a fair percentage of those from surrounding communities who seek out the center as their first health care option.
"We are not a squeaky clean private practice, but we are also not just a poor peoples' clinic," said West. "You can walk into our waiting room, and you are sitting in there with teachers and other professionals. At the same time, you are sitting next to an uninsured, unemployed mother of four or a person who is disabled or a street drug addict."
The center is one of about 700 community, migrant and homeless health centers nationwide that serve about 3,300 urban and rural communities. About 50 percent of the centers' physicians are family physicians, according to the Robert Graham Center in Washington. The centers provide care to more than 14 million people, according to the National Association of Community Health Centers. And the number of centers is growing at a rapid rate.
By the end of March, HHS was to have opened or expanded 614 community and migrant health centers under President Bush's plan for the sites. The fiscal year 2005 budget proposes an increase of $218 million to open or expand 330 more sites. By 2006, another 260 sites will come on board, according to the president's plan.
Does Congress back the plan? You bet. The House Appropriations Committee, in a July 14 voice vote, upped the ante for community health centers by exactly what the administration wanted: $218 million (from about $1.6 billion for 2004 to about $1.8 billion for 2005). But will there be enough FPs to staff the centers? Maybe not -- see "Contact Lawmakers Now: Funding to Train FPs in Jeopardy Again."
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
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Copyright © 2004 by American Academy of Family Physicians.