At a time when members of Congress can't seem to agree on much related to health care, a bill introduced this week in the House has -- and deserves -- strong bipartisan support.
Rep. Cathy McMorris Rodgers, R-Wash., and 49 co-sponsors have introduced the Training the Next Generation of Primary Care Doctors Act of 2017. If enacted, the bill would reauthorize the teaching health center graduate medical extension (THCGME) program through 2020 and provide funding for its continuation. Without congressional action, this vital program will expire Sept. 30.
The program, which was created by the Patient Protection and Affordable Care Act in 2010, addresses three key workforce issues: the severe shortage of primary care physicians, their geographic maldistribution and the need for physicians willing to serve in medically underserved areas.
The program provides GME funding directly to community-based health centers that expand or establish new primary care residency programs, and the incentive has worked. There were 295 family medicine residency slots at THCs in the 2016-17 academic year, up from 49 in 2011-12. In all, there were 740 primary care residents trained in 59 THC residencies in 27 states and Washington, D.C., in the recently completed academic year. THC residents and faculty are expected to provide more than 1 million patient visits this year in underserved communities.
Access to care is critical. A CDC report released earlier this year found that rural patients are more likely than their urban counterparts to die from the five leading causes of death: heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke. The same report said the percentage of deaths that were potentially preventable were higher in rural areas than in urban areas.
HHS' National Center for Health Workforce Analysis estimates the shortage of primary care physicians will top 23,000 by 2025, and the THCGME program invests in care where it's needed most. During the 2014-15 academic year, 84 percent of THC residents trained in medically underserved communities, and 22 percent trained in rural areas.
That's important because a national survey of third-year family medicine residents by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care found that those who trained in THCs were nearly twice as likely to practice in safety-net clinics than residents who trained in traditional family medicine programs.
In general, we know that more than half of family medicine residents will practice within 100 miles of their training sites, so locating programs in communities where they are needed addresses the maldistribution of physicians and increases access to care for the underserved.
THCs accounted for 33 percent of the increase in family medicine residency slots between 2011 and 2015, but no new slots have been created since initial funding for the program ended two years ago. The Medicare Access and CHIP Reauthorization Act of 2015 extended the program, but Congress opted to provide funding for just two more years (notably, one year short of the length of a family medicine residency). The same legislation cut funding per resident 40 percent, from $150,000 to $90,000.
The newly introduced THCGME bill would extend the program for three years with $116.5 million in annual funding. This additional money could support the current residency slots at the recommended amount of $157,000 per resident and provide an additional $20 million for new programs in rural and underserved communities.
The bill also would maintain mandated reporting requirements to ensure the program is working. Accountability standards require reporting on the number of patients treated, the number and percentage of residents that stay in primary care, and the number and percentage of residents who continue serving in rural and medically underserved areas. The bill will also require cost reports by the end of 2020.
The AAFP has released a statement to tell the public why this bill is important. Now you can add your voice to help preserve access to care for the underserved and maintain needed family medicine residency slots. The AAFP's Speak Out tool makes it easy to tell your legislators to reauthorize the program.
John Meigs, M.D., is president of the AAFP.