• In The Trenches

    We Told Congress How to Strengthen the Health Care Workforce

    Feb. 28, 2023

    By Stephanie Quinn
    Senior vice president of advocacy, practice advancement and policy

    The Senate Committee on Health, Education Labor and Pensions recently asked a pretty broad question about the nation’s shorthanded health care workforce. Naturally, the Academy replied with some specific answers.

    The through line of the nine calls to action we shared for the record of a Feb. 16 hearing titled “Examining Health Care Workforce Shortages: Where Do We Go From Here?” is that solving the problem starts with focusing on the primary care shortage — a projected deficit of 48,000 physicians by 2034. The question isn’t where we go from here; it’s how fast lawmakers can invest in primary care in the ways we’re talking about.

    (By the way, you can talk about this to lawmakers yourself in a new Speak Out campaign or in person at the AAFP’s 2023 Family Medicine Advocacy Summit. More on that later.)

    Congress has already heard a lot from the AAFP on these topics, including the very same committee. But now we’re just weeks away from the May 11 official end of the COVID-19 public health emergency, a point likely to increase pressure on primary care practices and patients as systemic changes take hold. The Academy is pushing the administration to firm its preparations for that date. Congress also must act fast to protect the comprehensive, longitudinal primary care that family physicians give their patients, we told the committee.

    Then we told them how to do it: 

    Doctor and Patient

    1. Fund More Training

    It’s no surprise that we started with a call to target and strengthen the Teaching Health Center Graduate Medical Education program, among other federal GME efforts. THCGME has trained more than 1,730 primary care physicians and dentists, 63% of whom are family physicians. We know the program is successful in tackling the issue of physician maldistribution and helps attract and retain physicians in rural areas and medically underserved communities. We also know that flat funding of the program would mean a 40% to 50% reduction in per-resident allocation for THC programs, putting them at risk of closure.

    Congress, then, should permanently authorize and expand the THCGME program by reintroducing and passing the Doctors of Community Act.

    You’ll recall that a year ago this month, the Academy scored a win when the Health Resources and Services Administration said it would allocate $19.2 million from the American Rescue Plan to fund 120 full-time THCGME residents and, in turn, strengthen access in rural and underserved areas. To stay on that correct path, we said, any expansion of Medicare GME slots should target hospitals and programs in areas and specialties of need, emphasizing those proven to train physicians who ultimately practice in physician shortage areas. How do we do that when Medicare, the largest single GME payer (to the tune of $16 billion annually), does not assess how those funds are used or whether they address shortages?

    To fill this information gap and strengthen federal GME programs, we called on Congress to pass legislation granting HHS and CMS the authority to collect and analyze data on how Medicare GME positions align with national workforce needs, and to publish that information annually.

    2. Increase Diversity

    Among other investments in diversifying the health care workforce to improve patient access, reduce spending and better meet the needs of an increasingly diverse population, we urged Congress to reintroduce and pass the Strengthening America’s Health Care Readiness Act. We support this legislation because it would increase investment in the National Health Service Corps. Forty percent of funding from the bill is set aside for racial and ethnic minorities, and students from low-income urban and rural areas.

    We also advocate for Congress to reintroduce and pass the Conrad State 30 & Physician Access Act, which would provide immigration certainty to thousands of international medical graduates who care for patients in underserved communities.

    3. Lower Student Debt

    We reminded the committee that the average student loan debt for four years of medical school, undergraduate studies and higher education averages $200,000 to $250,000 and that loan forgiveness or repayment programs directly influence physicians’ practice choice. Reducing student debt will diversify the physician pipeline and help reduce physician shortages.

    “Congress should expand funding for federal programs, including the National Health Service Corps Program, that incentivize physicians to go into primary care practice by providing loan forgiveness,” we said. Reintroducing and passing the Resident Education Deferred Interest Act would be big, too; that bill would allow medical residents to defer their student loans interest free during residency. Interest on medical student loans also should be deductible on federal tax returns, we said.

    4. End Noncompete Agreements

    Family physicians nationwide — including many of you in the Academy’s Congress of Delegates — have spoken out against noncompete agreements, which force physicians to stay in undesirable employment situations while limiting their financial prospects and compromising their mental health. Obviously, that’s also bad for patients.

    That’s why we took this opportunity to urge passage of legislation banning noncompete clauses in physician employment contracts. It’s simple: Patients should have access to their physicians, and physicians should be able to freely practice in their communities.

    This is part of our workforce advocacy you can take part in right now by joining the AAFP’s newest Speak Out campaign, centered on raising congressional support for a proposed Federal Trade Commission rule banning non-compete clauses. Getting this done would swiftly improve continuity of care for patients and allow more family physicians to work freely in their communities.

    We also recommended that Congress

    • invest in primary care by ensuring fair and sustainable Medicare and Medicaid physician payment;
    • support physician-led, team-based care and the integration of behavioral health and primary care by funding programs including the Primary Care Training Enhancement Program and by enacting policies that incentivize physician-led, comprehensive care teams; and
    • enact telehealth policies that extend the capacity of the existing health care workforce by ensuring patients and clinicians have flexibility to choose the most appropriate modality of care.

    Finally, we once again challenged lawmakers to increase federal funding for primary care research. This would not be hard to do, given that primary care research makes up less than 0.4% of the National Institutes of Health budget.

    The lack of national definitions and benchmarks, along with methodological differences across states and challenges obtaining data across payer types, adds difficulty, but the Academy is doing its part. Our Robert Graham Center (in collaboration with other partners) this month issued a scorecard, which we believe will help Congress do what we’re asking: invest in better data to more accurate measure primary care spending and changes in the primary care workforce.

    Your Turn

    As you think about the calls to action I’ve outlined here, please also consider joining me in Washington, D.C., May 22-23 for the AAFP’s 2023 Family Medicine Advocacy Summit.

    Our congressional testimony is always important, but there’s nothing more powerful than telling your own story, in person, to your elected officials. Ahead of your time advocating for your practice and your patients, you’ll learn how to communicate your aims powerfully and succinctly while earning CME. I hope to see you there.



    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.