AAFP President Tells Obama of Need to Strengthen the Nation's Primary Care Workforce

Health care coverage should be expanded to include everyone in the United States, but it's also essential to take steps to fix the nation's primary care workforce so patients actually have access to that care, AAFP President Ted Epperly, M.D., of Boise, Idaho, told President Obama during a March 5 White House health care summit.

"Speaking on behalf of over 100,000 family doctors, we're ready to do our part," Epperly said, responding to a question posed by Obama during the question-and-answer part of the summit.

"We'll roll up our shirt sleeves and do everything possible to make (health care reform) work because it is the right thing to do," Epperly told the president. But, he added, "we need to fix the workforce, sir, so that all those patients have a place to go."

Obama convened the summit to build bipartisan support for a major overhaul of the nation's health care system, summoning some 120 lawmakers, stakeholders and concerned citizens to the White House to work on issues surrounding health care reform. Stakeholders included representatives from the AMA, the American Academy of Pediatrics and the American College of Cardiology.

Obama called on Epperly to solicit the views of the physician community, a move that demonstrates the president's "respect for what the Academy is doing," said Epperly in a subsequent interview with AAFP News Now.

"For the Academy to be called on when there were other physician groups in the room is the ultimate sign of respect," said Epperly.

Obama said during the forum, "We are not producing enough primary care physicians because the costs of medical education are so high that people feel they've got to specialize."

The president also said the health care reform process must address "the enormous pressure and strain that the medical profession is now feeling from a whole variety of sources." Obama pointed out that the administration's 2010 budget proposal contains money to prevent deep reductions in the Medicare payment rates that are scheduled to take place under the sustainable growth rate formula.

Obama also reiterated his commitment to enacting major health care reform by the end of this year, telling the summit members, "now is exactly the time for us to deal with this problem."

"There's been some talk about the notion that maybe we're taking on too much; that we're in the midst of an economic crisis and that the system is overloaded, and so we should put this off for another day," Obama said. "Well, let's just be clear. When times were good, we didn't get it done. When we had mild recessions, we didn't get it done. When we were in peacetime, we did not get it done. When we were at war, we did not get it done."

"There is always a reason not to do it," he added.

Obama acknowledged that people are skeptical about whether Washington can truly enact comprehensive health care reform. "Our inability to reform health care in the past is just one example of how special interests have had their way and public interest has fallen by the wayside," he said.

But this time it's different, Obama added, because "the call for reform is coming from the bottom up and from all across the spectrum."

"Each of us must accept that none of us will get everything that we want and that no proposal for reform will be perfect," he said. "If that's the measure, we will never get anything done. But when it comes to addressing our health care challenge, we can no longer let the perfect be the enemy of the essential."

Epperly agreed with those sentiments. "We must all be patient in regards to moving in the right direction," he said in the interview. Any health care reform initiative adopted "probably won't give us everything we want, at least initially. But there is clearly an understanding and recognition by the administration and Congress for what family physicians do. And there will be efforts to improve family medicine and primary care in this country."

"The needle is moving in the right direction," he added.

Epperly also said he is impressed by the administration's commitment to allow people to keep their current health insurance under proposed health care reform measures.

"I like the fact that (Obama) said we are not going to blow the current system up, but we are going to build on top of it," Epperly said.

Obama, meanwhile, made a point of addressing rising health care costs, saying that health care inflation is the one issue that can make or break major reform efforts.

"The same soaring costs that are straining families' budgets are sinking our businesses and eating up our government's budgets," he said. "Too many small businesses can't insure their employees. Major American corporations are struggling to compete with their foreign counterparts."

Obama also said he does not see the United States fixing Medicaid and Medicare programs without fixing the underlying problem of health care inflation.

"Our most urgent task is to drive down costs both on the private side and on the public side," he said.

During the summit, participants broke out into working groups to share ideas and concepts on health care reform.

Epperly sat in on a working group led by Nancy-Ann DeParle, head of the White House Office for Health Reform, that was attended by a host of lawmakers, including Rep. Henry Waxman, D-Calif, chair of the House Energy and Commerce Committee; Sen. Max Baucus, D-Mont, chair of the Senate Finance Committee; Sen. Charles Grassley, R-Iowa, ranking member of the Senate Finance Committee; and Reps. Joe Barton, R-Texas, ranking member of the Energy and Commerce Committee, and Jim Cooper, D-Tenn.

"It was a great group in terms of heavy hitters who have the power to make these things happen," Epperly said.

He added that the group talked about the need for increasing the primary care workforce and how to reform graduate medical education to produce more primary care physicians. There also was discussion on how to decrease health care costs and improve quality, said Epperly.