February 04, 2019 09:57 am News Staff – The primary-care bingo card filled up fast when the Senate Health, Education, Labor and Pensions (HELP) Committee met Jan. 29 to consider testimony(5 page PDF) from the Academy and other backers of the Teaching Health Center Graduate Medical Education (THCGME) program. Social determinants of health, investment, innovation, reproducibility, workforce challenges, maternal outcomes, rural medicine -- the committee heard these and other words and phrases crucial to the fight for family medicine.
The hearing followed the Jan. 18 introduction of S. 192, the Community and Public Health Programs Extension Act, and preceded a separate bill with bipartisan sponsorship, S. 304, which was filed on Jan. 31 with a focus on training the next generation of primary care physicians. Passage of either bill promises more than a mere bingo victory for the AAFP's priorities. And with the future of the specialty at stake, the Academy is calling on its members to contact their senators via a Speak Out campaign.
S. 192 would renew funding for the THCGME, National Health Service Corps and community health center programs for five years.
S. 304 would go further, authorizing adequate and sustainable funding for existing THC residency programs and supporting expansion into rural and underserved communities.
The Academy expressed strong support for that bill in a Jan. 30 letter(1 page PDF) to its sponsors -- Sens. Shelley Moore Capito, R-W. Va.; Susan Collins, R-Maine; Doug Jones, D-Ala.; and Jon Tester, D-Mont. The bill would, the AAFP said, address "the serious shortage of primary care physicians, the geographic maldistribution of physician training and the need to increase health care access for medically underserved populations."
The renewed focus on the THCGME program follows many months of uncertainty. The HELP hearing convened exactly one year after (then) AAFP Board Chair John Meigs, M.D., of Centreville, Ala., wrote that Congress had failed physicians and communities in September 2017, when it began funding the program through a series of extensions that left recruiting and program administration in doubt.
Sen. Patty Murray, D-Wash. -- who, with Sen. Lamar Alexander, R-Tenn., sponsored S. 192 -- acknowledged the lost time in her opening remarks, telling her peers, "This time last year, community health centers across the country were forced to cut back hours, staff and services, and halt planned expansions. … This time last year, community health centers were left wondering how to pay their current staff and attract new professionals."
Accompanying the Academy's letter, signed by Board Chair Michael Munger, M.D., of Overland Park, Kan., was the AAFP's written testimony outlining the urgent need for robust backing of the THCGME program.
The Academy cited an Annals of Family Medicine projection that the U.S. population will require an additional 33,000 primary care physicians by 2035, as well as a 2017 Government Accountability Office report warning that physician maldistribution negatively affects rural communities. To alter the skewed concentration of primary care physicians in just a handful of U.S. population centers, research suggests that learning and career opportunities must be supported in underserved areas.
"Primary care workforce programs, such as the THCGME program and the National Health Service Corps program, are essential resources to begin to increase the number of primary care physicians and to ensure they work in communities that need them most," the AAFP's statement said. "The THCGME program appropriately trains residents who then stay in the community. "
Residents who train in community health centers, the statement added, "also have the unique opportunity to be trained in delivery system models using electronic health records, providing culturally competent care and following care coordination protocols. Some are also able to operate in environments where they are trained in mental health, drug- and substance-use treatment, and chronic pain management."
AAFP members John Waits, M.D., of Centreville, Ala., and Andrea Anderson, M.D., of Washington, D.C., echoed the Academy's statement in live testimony before the committee.
"The beauty of the teaching health center, situated in rural or urban community health centers, is that it matches the training to the community's needs," Waits said.
Anderson, a veteran of the National Health Service Corps who also has worked in a community health center, added, "I now teach in a teaching health center residency, and I can say that I would send any one of my family members to those residents because I am confident that they have the skills and the passion to serve in the gap of what America's health needs are today."
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