Some Solutions

Education economists and analysts recommend allocating graduate medical education funds directly to primary care residency programs, increasing support for Health Professions Training Grants, and closing the income gap between primary care physicians and subspecialists. Together, these efforts will do much to increase medical student interest in careers in primary care.

Redistribute GME funding

By carving out a portion of overall GME funding and allocating that money directly to community-based primary care residency programs(4 page PDF), the federal government could continue funding academic health centers’ other residency programs, secure the production of primary care physicians, train residents in the types of settings where they are most needed, and increase accountability for generous public funding. The Primary Care Workforce Access Improvement Act of 2011, HR 3667 (12 page PDF)would establish demonstration programs that would test the efficacy of GME redistribution.

Increase support for Health Professions Training Programs and National Health Service Corps

Numerous studies demonstrate that schools receiving Title VII primary care grants graduate more students who go into primary care and who care for the underserved(www.graham-center.org) and who work with community health centers(www.graham-center.org). However, Title VII funding has plummeted(www.graham-center.org) from more than $92, million in 2003 to $39 million in 2012. Federal support for NHSC has grown from $123.4 million in 2008 to $295 million in 2012. The AAFP supports continued growth in NHSC funding(2 page PDF), and has recommended funding increase to $418 million.

Close the gap between primary medical care and subspecialty care payment

Physician payment should compensate for the increasingly complex expertise required of primary care physicians. Under the current fee-for-service system that pays more for procedures than it pays for prevention(www.annals.org), the income difference between primary care and subspecialty care has grown dramatically. This disparity adversely affects student specialty choices.(www.graham-center.org) The Council on Graduate Medical Education has called for “dramatic” and swift changes in policies to increase the supply of primary care physicians “to at least 40 percent from the current level of 32 percent” and to raise the average incomes of primary care physicians to “at least 70 percent of median incomes of all other physicians.” The report also calls on medical schools to strategically change “the processes of medical student and resident selection” and to change the educational environment.