Family physicians and other primary care advocates recently went to bat for primary care on Capitol Hill, testifying before a Senate subcommittee about the key importance of funding education and training initiatives that will provide the physicians the nation needs and deserves.
At an April 9 hearing(www.help.senate.gov) of the Senate Committee on Health, Education, Labor and Pensions' Subcommittee on Primary Health and Aging, physicians and health care administrators discussed how the nation's health care needs are tied to creating incentives -- and mitigating disincentives -- for medical students to enter primary care.
Joseph Nichols, M.D., a family medicine resident at MedStar Franklin Square Family Health Center in Baltimore, detailed his career path and how he made the choice to become a primary care physician. Diagnosed as having acute lymphoblastic leukemia at age 3, Nichols initially dreamed of becoming a pediatric oncologist, That is, until a conversation with his mentor -- a pioneer in pediatric oncology -- convinced him otherwise.
"This wise physician, whose life's work saved my life, encouraged me not to follow in his footsteps, but instead to go where the need was now greatest ... To him, the need was now greatest for primary care physicians," Nichols testified.
"Primary care is something needed and deserved by everyone, and yet it has a constituency of no one," he told the senators. "Nobody raises her hand and says, 'I have primary care disease.'"
- During recent testimony before a Senate subcommittee, one family medicine resident said his medical school colleagues chose other specialties because of their school debt.
- Teaching health centers are a focal point of primary care training, said one residency director, but they need continued federal funding.
- Medical students say they are interested in primary care, another speaker testified, but the disincentives too often outweigh the field's positive aspects.
His own choice notwithstanding, Nichols said he can understand why many of his medical school colleagues chose more lucrative medical specialties. "Even at the least expensive private medical school in the country, many medical students abandon plans of becoming primary care doctors because of student loan debt," he testified.
Another factor discouraging medical students from choosing a career in primary care, according to Nichols, is that although the primary care facilities where many of these students train lack adequate resources, they are often charged with caring for patients with the greatest medical needs. The frustration imposed by this combination of limited resources and high patient demands has deterred many from entering the primary care field.
Nichols recalled that while attending medical school at Baylor University, the school's dean of students encouraged and praised those who chose primary care, telling them, "You are the real doctors." Yet as pleased as he was to hear this affirmation, said Nichols, it was unfortunate that this recognition came only after he had declared his specialty choice rather than at the beginning of his studies.
Also testifying during the hearing was Deborah Edberg, M.D., program director for the family medicine residency at the Erie Family Center in Chicago, who spoke in support of continuing funding for the Teaching Health Center Graduate Medical Education (THCGME) program established as part of the Patient Protection and Affordable Care Act. The program launched in fiscal year 2011 and is funded only through FY 2015.
The program supports 36 teaching health centers nationally, which train about 300 residents. Noting that teaching health centers are the only facilities in the country that receive funding specifically to train primary care physicians in a community setting, Edberg told hearing participants that residents trained in these centers are three times more likely to remain in primary care. The centers help address the shortage of primary care physicians overall while treating medically underserved populations, she said.
Still, "despite the promise and scope of community health centers and the urgent need for more primary care providers, we face a significant challenge in recruiting the number of qualified primary care physicians necessary to meet demand," said Edberg.
Because funding is set to expire next year, Edberg said her residency program, which offers eight residency positions, must decide whether to accept students who will not be guaranteed funding for their entire three-year tenure.
Notably, Sen. Bernard Sanders (I-Vt.), who chairs the subcommittee, recently introduced legislation that would reauthorize the THCGME program and provide the necessary financial support.
According to family physician Allen Dobson Jr., M.D., president and CEO of Community Care of North Carolina, his state is a model in many ways for addressing primary care needs among its population. Over 90 percent of primary care physicians participate in Medicaid, he testified during the hearing, and reimbursement rates in North Carolina are higher than those in surrounding states. Medicaid growth has remained largely steady in recent years, Dobson said, unlike in many states where it has skyrocketed.
Yet North Carolina faces a shortage of primary care physicians because only a small percentage of its medical school graduates choose the field.
Dobson said he spoke with residents and medical students in North Carolina about their future in medicine. Many of them said that instead of working at a medical center when they finished their residency, they would choose to be a primary care physician in a small town -- if they did not have to worry about medical school debt or income.
"The problem is we don't have an infrastructure to support those choices," he said. "We need to train (residents) where they are going to practice and in the style that they are going to practice."