Primary Care Health Professionals in Short Supply at CHCs

The nation's community health centers, or CHCs, are suffering from a shortage of primary care professionals that will continue to worsen unless federal and state governments take steps to boost the primary care workforce. So says a recently released study (40-page PDF; About PDFs) by the National Association of Community Health Centers, AAFP's Robert Graham Center in Washington and George Washington University.

The country's roughly 6,600 health centers provide health care to about 18 million people, according to "ACCESS Transformed: Building a Primary Care Workforce for the 21st Century." CHCs need to hire an additional 1,843 primary care providers, including physicians, nurse practitioners, physician assistants and certified nurse midwives, as well as an additional 1,384 nurses, to meet standard provider-to-patient ratios used in other health care systems.

"Today, far too few medical graduates are choosing a career in primary care, and too few of them are choosing to practice in underserved areas," said Dan Hawkins, policy director for NACHC, during an August 11 conference call announcing the report's findings. "We can all learn a great deal from the state of Massachusetts where, a year after mandating universal health insurance, nearly twice as many adults reported they could not find a primary care physician, and therefore, they delayed or went without care."

The report also found that primary care clinicians are not locating in areas that need them the most, especially low-income communities.

"Health care disparities -- the hallmark of communities shut out of preventative medicine -- continue to widen between the haves and have-nots," the report states. "And, tragically, the United States is rated dead last among 19 other industrialized nations when it comes to premature deaths that could have been prevented by timely access to care."

Health care access is the "most pressing challenge to our health care system, where the landscape continues to fragment with costly and diminishing health care choices for consumers," says the report. "Indeed, if every person in America woke up tomorrow with an insurance card in their hand, they still would not be guaranteed access to primary care."

NACHC launched a campaign (9-page PDF; About PDFs) earlier this year to expand the capacity of CHCs, but that goal cannot be met unless federal and state governments take steps to make it happen, says the report. Federal and state governments have to strengthen, stabilize and expand workforce development programs to fortify the pipeline to primary care careers. This includes enhanced opportunities for students to participate in primary care education and training experiences while also increasing exposure to primary care for health professional students.

Although federal programs support educational infrastructure and training at medical, dental and nursing schools, these programs, along with primary care residencies that place residents in underserved areas, are in danger of losing funding.

"The health professions training programs are up for re-authorization, yet the (Bush) administration requested no appropriations for (the programs) in 2009," the report says. "Continued funding is a key factor in ensuring that more primary care physicians locate in underserved areas."

The report also calls for a revised payment system to reflect the essential role and value of primary care in the health care delivery system. This would attract more primary care professionals and improve access to primary and coordinated team-based care.

"Policy-makers are going to have to address (payment) to encourage more students to go into primary care," said Gary Wiltz, M.D., executive and clinical director of Teche Action Board, Inc., in Franklin, La., who participated in the Aug. 11 call with Hawkins. "Students, on average, are coming out with $250,000 to $300,000 worth of debt, and that is driving a lot of their decisions."

The report urges the federal government to increase funding for the National Health Service Corps from a current budget of $125 million to $700 million by 2015 to produce enough providers to meet NACHC's goal of reaching 30 million patients during the next seven years through health center expansion. The National Health Service Corps provides financial assistance to medical students who agree to practice primary care in underserved areas after graduation.

"We know that what we are talking about does not come cheaply, but the relatively modest investment we propose will provide significant dividends -- better health for more people and huge cost savings to the health care system," said Hawkins.

By reaching 30 million patients, CHCs could save the nation's health care system between $22.6 and $40.4 billion annually, and produce as much as $40.7 billion in economic benefits for their communities, according to the report.