Primary Care Physician Shortages Imperil Health Care Reform, Says AAFP President-elect

Health care reform will not succeed without an adequate supply of primary care physicians, making it incumbent upon Congress to enact policies that increase the nation's primary care physician workforce. That's what AAFP President-elect Lori Heim, M.D., of Vass, N.C., said during testimony before the House Small Business Committee here on July 8.

Heim told the committee that the current supply of primary care physicians is "far from adequate," and future projections about upcoming shortages are "truly alarming."

"Primary care has been described as the base of the health care workforce pyramid," said Heim, who spoke during a hearing on physician workforce shortages. "But the U.S. physician profile is only 31 percent primary care and 69 percent (sub)specialty care."

The AAFP supports steps to make primary care physicians at least 45 percent of the nation's health care workforce, said Heim, who urged Congress to adopt workforce policies that would train primary care physicians in the patient-centered medical home, or PCMH, model of care.

"To realize the quality and efficiency benefits of the patient-centered medical home, we must have an adequate supply of primary care doctors, particularly family physicians," said Heim.

She also called for an immediate payment increase for primary care physicians. An increase in payments would encourage more medical school students to choose careers as primary care physicians, said Heim. Moreover, it would allow physicians to redesign their practices around the concepts of the PCMH.

In addition, "Congress should provide targeted incentives, such as scholarships, loan forgiveness or other forms of debt relief, for medical students who chose primary care and family medicine," said Heim. "(The AAFP) also is recommending opportunities in programs such as the National Health Service Corps," which helps physicians repay their medical school loans in return for service in medically underserved areas.

Congress can take additional steps by reauthorizing and adequately funding Section 747 of Title VII of the Public Health Service Act, the only federal grants for training family physicians, Heim said. She also called for reforms of graduate medical education programs to make sure "we are training the primary care physician workforce we need."

Medical schools also have a role in increasing the number of primary care physicians, Heim said.

"We know from prior studies that there are certain types of medical students who are more likely to go into primary care," said Heim. These include older students and students from rural areas, she noted. Medical schools could use this type of information to increase the number of students who are interested in primary care.

Heim told the committee that the vast majority of family physicians are small business people, delivering care to communities across the nation. "Nearly 38 percent of family doctors practice in solo or two-physician practices," she said. "Studies indicate that more Americans depend on family physicians than on any other specialty. We see up close the hardship of the uninsured, and we struggle along with those patients who are insured but who then face coverage denials.

"The status quo is not working, neither for the physicians nor for patients," said Heim. "We urge Congress to invest in the health care system that we want, not the one we have now."

Rep. Nydia Velazquez, D-N.Y., chair of the Small Business Committee, agreed with Heim's points, saying, "the current physician shortage is already posing a significant threat to (health care) reform."

"Reform will bring more uninsured Americans into the fold, but it won't create more doctors to treat them," said Velazquez. "Take the 46 million newly insured, add in an aging baby boomer population, and you could very well have a recipe for disaster."

Velazquez described primary care as "an effective means for reigning in costs."

"That's because a person who gets regular checkups is less likely to develop serious conditions down the road," said Velazquez. "And considering that 75 percent of health care expenditures go toward treating chronic illnesses, primary care is critical."