Federal programs that will lose funding without immediate action from Congress are vital building blocks for primary care in underserved areas, a panel of physicians told congressional staff recently.
Family physician Maria Verduzco, M.D., says a National Health Service Corps program provides valuable assistance to Central Washington Family Medicine in Yakima, Wash., where she serves as site director.
Federal funding for the Teaching Health Center Graduate Medical Education (THCGME) program and the National Health Service Corps (NHSC) is set to expire Sept. 30. With this deadline approaching quickly, a group of primary care physicians discussed the programs' value in expanding access to care during a Sept. 20 forum(www.nchc.org) on Capitol Hill. The forum, titled "Avoiding the Cliff: Strengthening the Primary Care Workforce," was the third and final event in a series co-hosted by the AAFP and the National Coalition on Health Care.
The THCGME program addresses the fact that although urban hospital-based residencies are increasing, they are not adequately easing the primary care shortage or filling gaps in underserved areas.
"There is both an overall shortage of primary care physicians and a maldistribution," said Clif Knight, M.D., the AAFP's senior vice president for education.
- Panelists at a recent forum told congressional staff that programs facing a Sept. 30 funding deadline play crucial roles in improving primary care in underserved areas.
- The Teaching Health Center Graduate Medical Education program addresses the fact that urban hospital-based residencies are not adequately easing the primary care shortage or filling gaps in underserved areas.
- A National Health Service Corps program offers qualifying educational loan repayment in exchange for service in a designated health professional shortage area.
Pointing to its success in training an emerging generation of physicians to work where needs are greatest and in focusing on population health, Knight said the THCGME program should be expanded. Bills sponsored by Rep. Cathy McMorris Rodgers, R-Wash., and Sen. Susan Collins, R-Maine, would extend funding for three years.
"(THC) residency directors are trying to recruit students, but they don't know if they'll be there in three years because they don't know if they will have funding," Knight said. "A resident's ability to complete the program is at risk if the funding runs out. We have to fix that over the long term."
Preserving the THCGME program could have a great impact on the nation's health. There are 67 million people who live in the 6,708 designated health professional shortage areas in the United States. Adding one primary care physician per 10,000 residents could lead to a 5.3 percent reduction in mortality, equal to 49 fewer deaths per 100,000 annually, Knight said.
John Sealey, D.O., director of medical education for the Detroit Wayne County Health Authority, explained that the THCGME program allows communities to be innovative in designing their approach to patient care based on local population needs.
"If you train in a hospital, everything is the same," he said. "Communities with a THC have a distinct personality that residents learn to love, and that's why they stay."
Residents who train at the Authority Health THC(www.authorityhealth.org) in Detroit receive a certificate in population health and do rotations at a nearby Department of Veterans Affairs hospital facility. Sealey said hospital-based residencies, on the other hand, are hesitant to send residents on rotations outside their own facilities because they might not receive reimbursement.
Maria Verduzco, M.D., a family physician who is the site director for Central Washington Family Medicine(cwfmr.org) (CWFM) in Yakima, Wash., said she paid off the majority of her medical school loans through an NHSC program that offers qualifying educational loan repayment in exchange for service in a designated health professional shortage area
Verduzco recalled obtaining medical care at a community health center with her family when she was growing up in Washington, and she described the patients who receive care at CWFM. Sixty percent of the patients are Medicaid beneficiaries, and 16 percent are Medicare beneficiaries. Among Verduzco's patient panel, 70 percent are Latino.
Community health centers fill a vital gap in caring for low-income individuals and others who have limited access to health facilities, Verduzco said. She told of one patient, a 42-year-old woman with chronic hypertension who was pregnant with her fourth child. During her pregnancy, which was unplanned, the woman learned that her son died in a vehicle accident. Fortunately, the community health center had the facilities to handle the woman's multiple health needs.
"Having an on-site behavioral health specialist is so important to co-manage care for these patients," Verduzco said.
Thirty residents are training at CWFM, which will graduate its 25th class in 2018. Like Verduzco, many of the past and current residents received financial assistance from the NHSC program, which is a powerful recruiting tool for physicians who are hired after their residency.
"Without the NHSC, many of them would not be able to afford to work for us," Verduzco said.
One attendee asked the panel why Congress delays action when these programs have demonstrated a strong contribution to public health. Jack Ende, M.D., president of the American College of Physicians, replied that budget debates in Congress are a zero-sum game. But it's crucial for the THCGME program and the NHSC to secure continued funding.
"It would be a major step backward if these programs go unfunded," Ende said.
Related AAFP News Coverage
Residents Who Train in THCs More Drawn to Underserved Areas
More From AAFP