AAFP President Points Out Importance of Funding Primary Care Programs to Success of Health Care Reform Legislation

During recent testimony before a House subcommittee, AAFP President Lori Heim, M.D., of Vass, N.C., urged Congress to increase federal investment in the primary care physician workforce to help ensure successful implementation of the recently enacted health care reform law. The number of physicians in the education pipeline for primary care has to increase if health care reform is going to succeed, said Heim.

Heim's live testimony here on May 12 was a follow-up to written testimony submitted to House and Senate appropriations subcommittee members regarding increases in funding for key primary care-related programs in fiscal year 2011, or FY '11.

Heim told the House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies, "Despite the consensus that good primary care is essential for genuine health care reform, 65 million Americans -- about one in five -- live in a primary care shortage area." At the same time, said Heim, the percentage of primary care physicians produced by the medical education pipeline stands at about 22.6 percent, a drop of more than 10 percent from a decade ago.

Consequently, at the same time that more patients are coming into the health care system because of the new health care reform law, the United States will have fewer primary care physicians to care for them, said Heim.

She also stressed that physician shortages are particularly hard on rural Americans because they face more barriers to accessing care than their urban or suburban counterparts. "Family physicians provide the majority of care for America's underserved and rural populations," said Heim, emphasizing the importance of ensuring these areas have enough family physicians.

Although Subcommittee Chair David Obey, D-Wis., said he agreed with Heim regarding the need for more support for the primary care pipeline, he pointed out that Congress is operating under tight budget constraints, which will make it difficult to increase funding for primary care education programs and other primary care programs.

According to Obey, most Republicans and Blue Dog Democrats want to reduce discretionary funding. "I would love to provide the dollars you are talking about," he said during the hearing. "But we don't have the votes for it."

Heim testified that the AAFP wants the FY '11 federal budget to include a minimum of $600 million for Title VII training programs. "We also urge the committee to provide $170 million for Title VII, Section 747 primary care training and enhancement programs," she said. Section 747 of Title VII provides the only federal grants for the training of family physicians and is funded at $54 million in the current fiscal year.

Heim also called for full funding of Title VII rural physician training grants that were created by the health care reform legislation.

The health care reform law also authorizes innovative teaching health centers to train primary care residents in nonhospital settings, which is where most primary care is delivered, and Heim noted that if the program is to be effective, "there must be grants for planning."

Citing the role of student debt in discouraging medical students from pursuing careers in primary care, Heim also called for $414.1 million in funding for the National Health Service Corps, which "has long provided debt relief to primary care physicians and has helped to reduce health disparities."

In addition, she called for funding increases for the Agency for Healthcare Research and Quality, and she urged Congress to provide $120 million in FY '11 for a new primary care extension program created by the health care reform law. The new law calls for an appropriation of $120 million for the program.

"This new program will assist primary care providers in transforming their practices by using effective evidence-based therapies and techniques," Heim said.