Primary Care Essential to Controlling Health Care Costs, Says AAFP President

"(Although) cause and effect are sometimes hard to prove, almost all data show an incredibly strong correlation between increased numbers of primary care physicians caring for a population and slower growth in costs and higher quality of health care." That was the message AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, delivered during a March 1 congressional staff briefing on Capitol Hill.

Primary care is essential to achieving the simultaneous goals of controlling health care costs and improving quality, said Goertz. As a result, federal lawmakers must continue to support primary care workforce programs and take steps to better reward the value that primary care and family physicians bring to the health care system.

Goertz spoke as part of a three-member panel at the briefing, which was convened by the Partnership for Primary Care Workforce, a nonpartisan, nationwide effort to strengthen and improve America's primary care workforce. The AAFP is a founding member of the partnership. Other members of the panel were Tina Cheng, M.D., M.P.H., a professor of pediatrics at Johns Hopkins School of Medicine in Baltimore and past president of the American Academy of Pediatrics, and Stephen Shannon, D.O., M.P.H., president of the American Association of Colleges of Osteopathic Medicine.

During his part of the presentation, Goertz described some of the programs that have strengthened the nation's primary care infrastructure, including health professions grants found in Section 747 of Title VII of the Public Health Service Act, which provide funds for training family physicians, and the National Health Service Corps, or NHSC.

Title VII funding has promoted primary care training in both community and academic environments and has played a major role in the development of family medicine training programs, said Goertz. "The studies that have been done on medical schools and departments that have received funding from Title VII have a very good track record of producing more primary care physicians for needy areas in this country and more primary care physicians in general."

Goertz also praised the NHSC, which provides financial support for primary care physicians who agree to practice in underserved communities for a certain length of time. "Students look for a way to (pay off) debt as soon as possible, and the National Health Service Corps is a way to do so," he said. "It provides a valuable path for students to choose primary care."

Goertz also decried the income disparities between primary care and nonprimary care physicians. These income differentials are a major reason why the country is now facing a shortage of primary care physicians, said Goertz.

Goertz's co-panelist Cheng addressed the future of health care, telling the audience that "education and training of our health care providers is an integral part of preparing our country to meet the health care needs of the future. (But) because of the time required to train health care professionals, we must make an appropriate investment today so that we have the health care providers we need for tomorrow."

Cheng called for building on the success of existing workforce programs, such as Title VII, the NHSC and teaching health centers, while doing more to adequately compensate primary care physicians and other primary care health professionals.

Meanwhile, Shannon pointed out that heath care in the United States has shifted from a hospital-based system to more of an ambulatory-care model during the past 20 years.

"We have gotten better at preventing, diagnosing and managing chronic diseases," said Shannon. "We have better tools, better technology, better medications, and we get better outcomes with people who are in the system of primary care delivery."

He stressed, however, that effective care of patients with chronic diseases requires more than just a face-to-face encounter with a primary care physician at the time of the health problem. "It requires ongoing management, and communication with (sub)specialists and health care providers, as well as monitoring and communication with patients and their families," he said.

Yet, primary care physicians, for the most part, are not compensated for providing these services under Medicare or the prevailing fee-for-service payment structure, Shannon noted.