The Academy recently sent pointed commentary to a legislative task force examining a key U.S. health care challenge: rural medicine.
An adequate physician workforce in rural and underserved areas "is at least as important as the ratio of patients to physician," the AAFP told the House Ways and Means Committee's Rural and Underserved Communities Health Task Force in a Nov. 26 letter.(6 page PDF)
"A functional system includes a capability to handle obstetrical, medical and trauma-related crises for all age groups. Well-trained family physicians and provider teams can fulfill this role," added the letter, signed by Board Chair John Cullen, M.D., of Valdez, Alaska.
Right now, however, lower Medicaid payments to family physicians, scores of rural hospital closures, dramatic hospital and insurance company consolidation, spiraling administrative burdens and other factors have coalesced into a crisis that's putting rural and underserved inner-city patients at risk, the Academy wrote.
The AAFP was responding to the task force's Nov. 15 request for information.(waysandmeans.house.gov) Its letter was sent to Reps. Danny Davis, D-Ill.; Brad Wenstrup, R-Ohio; Terri Sewell, D-Ala.; and Jodey Arrington, R.-Texas.
Noting that 17% of AAFP members practice in rural communities -- the highest percentage of any medical specialty -- the Academy directed the task force to its Rural Health Matters initiative as a resource for understanding the roots of the crisis.
The ratio of primary care physicians to patients in rural areas is just 39.8 physicians per 100,000 people, compared with 53.3 physicians per 100,000 in urban areas. This workforce shortage disproportionately affects rural Americans in part because graduate medical education training is not evenly distributed nationwide, the Academy told lawmakers, "and because costly and burdensome administrative requirements are threatening the financial viability of solo and small physician practices."
"Rural communities also tend to have higher rates of poverty and rural residents are more likely than their urban and suburban counterparts to be uninsured or underinsured," the letter added. "Lack of parity between Medicaid and Medicare payment rates disproportionately impacts access for rural, low-income, disabled and elderly Medicaid enrollees, as Medicaid payments fall below the actual cost of delivering care in those areas."
At the same time, 42% of visits that Americans make to physicians each year are to family physicians -- even as traditional Medicare graduate medical education, the Academy said, does not provide an adequate number of family medicine residency positions to increase the number of medical school graduates making a career choice of family medicine.
To address this crucial gap, the letter asked task force members to refer to the AAFP's policy on graduate medical education financing.
The task force asked for examples of efforts needed to strengthen patient safety and care quality in health systems that provide care to rural and underserved populations. The Academy's response advocated for several key investments in primary care, including
- implementing and expanding primary care multipayer models founded on the key functions of the medical home that increase investment in primary care;
- ensuring that value-based payment models make appropriate adjustments to quality and utilization assessment for rural practices;
- applying the Federal Tort Claims Act to lower malpractice insurance costs for certain rural health centers;
- removing barriers that lack an evidence base and are based solely on physician specialty so primary care physicians can practice at the fullest scope;
- robustly funding the Teaching Health Center Graduate Medical Education program;
- supporting the Rural Residency Planning and Development Program, rural preceptorships, rural residency rotations, designated rural training tracks and J-1 visa waivers; and
- continuing funding for the National Health Service Corps.
"Increasing investment in primary care could strengthen patient safety and care quality in health systems that provide care to rural and underserved populations," the Academy said.
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Robert Graham Center for Policy Studies in Family Medicine and Primary Care: Addressing Rural Workforce Shortages and Healthcare Disparities: An Annotated Bibliography(www.graham-center.org)