Success of Health Care Reform Depends on Strong Primary Care Physician Workforce

AAFP report calls for revamping educational, health delivery and payment systems

Wednesday, October 14, 2009


Health care reform in the United States will not succeed unless it includes policies that encourage tens of thousands of medical students to choose primary medical care specialties.

That is the message of the Family Physician Workforce Reform: Recommendations of the American Academy of Family Physicians, a 2009 policy approved by the AAFP Congress of Delegates today.

“Health care reform that provides coverage to the uninsured is essential to the welfare of our nation. But equally essential is ensuring that Americans can see a personal physician when they need one,” said Ted Epperly, MD, president of the AAFP. “Family physicians and their primary care colleagues are the first contact people have with the health care system. Primary care physicians are the doctors who provide preventive care to keep Americans healthy and ongoing, comprehensive, and coordinated care when they get sick. A shortage of primary care physicians translates into a lack of access to care for Americans.”

The report calls for several systemic changes, including:

  • rebalancing the health delivery system on primary care provided in a patient-centered medical home; developing, testing, and implementing new physician payment models, such as the patient-centered medical home;
  • establishing a 10-year national plan that targets 50 percent of the total number of U.S. physicians to practice in true primary care specialties (family medicine, general pediatrics and general internal medicine);
  • encouraging medical schools to admit students most likely to choose primary medical care specialties by dedicating a portion of the new medical school slots to family medicine or other primary care careers and designating preferential funding for medical schools that produce more primary care physicians; and
  • increasing funding for Title VII of the Public Health Service Act and loan repayment programs for primary medical care careers and expanding National Health Service Corps opportunities and establishing a Senior NHSC.

Without rebalancing the health system on primary care, the United States will continue to see fragmented and more costly care, the report says.

“The increasing generalist-specialist imbalance in the United States undermines the nation’s ability to achieve universal health care access and limits its ability to meet needs of underserved rural and urban populations,” the report says. “Primary care services provided by limited specialists and sub-specialists who have had little or no primary care training or continuing education can be expected to be both costly and inefficient, because limited specialists tend to use technologies and procedures of their specialties more than generalists. Furthermore, because of their narrower educational focus, limited specialists will more frequently seek consultation for patients who have common acute and chronic illnesses. Services may be fragmented and duplicated by visits to multiple specialists, and preventive services may not be provided adequately.”

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Founded in 1947, the American Academy of Family Physicians represents 134,600 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

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