Obama Administration Announces Investment in Primary Care Physician Training

The Obama administration has officially unveiled a series of investments to expand the nation's primary care workforce, including measures to train more than 500 new primary care physicians by 2015.

The initiative, which is funded by the recently enacted health care reform law, provides $250 million to increase the nation's supply of primary care health professionals; $168 million will go toward creating more residency slots to train more than 500 new primary care physicians during the next five years, according to a June 16 HHS news release.

"I think this reflects what we have said all along -- that this administration is solidly behind primary care, and that they understand that primary care and family medicine have to be the cornerstone of the health care system," said AAFP President Lori Heim, M.D., of Vass, N.C., in an interview with AAFP News Now.

The initiative also sets aside $5 million for states to plan and implement strategies to expand their primary care workforces by 10 percent to 25 percent during the next 10 years to meet the increased demand for primary care services. It provides another $32 million to train more than 600 new physician assistants, and gives $30 million to help more than 600 nursing students attend school full time, so they can earn their nursing degrees faster.

In announcing the investments, HHS was vague in spelling out just how the money would be used to bolster the nation's primary care workforce.

The $250 million investment in the nation's primary care workforce is the first allocation from a new $500 million prevention and public health fund for the current fiscal year created by the Patient Protection and Affordable Care Act.

However, some leading congressional Democrats, including Sen. Tom Harkin, D-Iowa, and Rep. Henry Waxman, D-Calif., have criticized the use of the $250 million for primary care workforce investments, saying that was not how the money was supposed to be used under the provisions of the health care reform legislation.

Nevertheless, said Heim, the AAFP is "pleased the administration is releasing this money."

"These are the steps needed to make sure we have the primary care workforce to enact the goals of health care reform legislation," she said.

However, the initiative also provides $15 million to establish 10 new nurse practitioner-led clinics, an approach that is misguided, according to Heim.

"That clearly is the wrong direction," she said. "We have consistently said that in order for the patient-centered medical home to be successful, they have to be physician-led. That is where you get the greatest benefit."

Although nurse practitioners are an integral part of the health care team, they lack the comprehensiveness required to lead a patient-centered medical home, Heim added. "We are concerned that they will not be able to achieve the cost savings and quality we see in physician-led practices."

In its press release, HHS pointed out that primary care shortages are increasing just when an aging nation needs primary care health professionals the most.

"The Association of American Medical Colleges estimated that the nation would have a shortage of approximately 21,000 primary care professionals in 2015," said HHS. "Without action, experts project a continued primary care shortfall due to the needs of an aging population and a decline in the number of medical students choosing primary care."

The health care reform bill also includes several measures designed to increase student interest in primary care, including loan forgiveness programs and scholarship programs.

HHS Secretary Kathleen Sebelius said in a prepared statement that the new investments "will strengthen our primary care workforce to ensure that more Americans can get the quality care they need to stay healthy."

"Primary care providers are on the front line in helping Americans stay healthy by preventing disease, treating illness and helping to manage chronic conditions," said Sebelius. "These investments build on the administration's strong commitment to training the primary care doctors and nurses of tomorrow and improving both health care quality and access for Americans throughout the country."