Building Primary Care Workforce, Boosting Pay Go Hand in Hand, Says COGME

AAFP President Welcomes Report's Support for Academy Goals

February 05, 2011 12:40 am Barbara Bein

AAFP leaders are lauding the release of a new report from the Council on Graduate Medical Education, or COGME, saying it provides welcome support for their calls to boost the primary care physician workforce and narrow the gap in incomes between primary care physicians and those in other specialties.

COGME's 20th report( to the HHS secretary and the U.S. Congress, dubbed Advancing Primary Care, recommends that the percentage of primary care physicians -- defined as family physicians, general internists and general pediatricians -- increase from 32 percent to 40 percent of the total U.S. physician workforce and that these physicians' average incomes be increased to at least 70 percent of the median incomes of all other physicians.

AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, told AAFP News Now he is pleased that another entity in Washington is backing changes similar to those the Academy has been promoting for years.

"I'm enthusiastic that there are more voices from entities that have been given responsibility on these issues, and they have similar recommendations to make on payment and workforce reforms," he said.

AAFP Has Resources to Build Pipeline to Family Medicine

The AAFP Division of Medical Education has developed a number of resources to promote student interest in family medicine. They're all available from the Academy's Virtual Family Medicine Interest Group website.

For premedical students, Explore Family Medicine: A Roadmap for Your Future(4 page PDF), offers a bird's eye view of what it means to become a family physician and what to expect along the way. There's also a resource list to help those considering a career in medicine, as well as information on managing medical school debt.

For medical students, there are mentoring resources; information for minority students; and Strolling Through the Match, a primer on the National Resident Matching Program.

Residents-to-be also can learn how to research and select residency programs and get advice on transitioning to residency.

The AAFP's 2009 Policy on Family Physician Workforce Reform also calls for boosting the primary care workforce and remedying income gaps. In the present climate of health care reform, however, "there's much more awareness of the problems and of the solutions, and family medicine is more recognized as part of the solutions," said Goertz.

Five Challenge Areas Identified

In its report, COGME developed specific recommendations to address challenges in five areas:

  • the number of primary care physicians,
  • mechanisms of primary care physician payment and practice transformation,
  • the premedical and medical school environment,
  • the GME environment, and
  • the geographic and socioeconomic maldistribution of physicians.

According to the report, policies and programs should be implemented to enhance and support the practice of primary care and to increase the supply of primary care physicians. Moreover, policy changes should be dramatic, have an immediate effect, and not favor slow and incremental change.

In addition to recommending income increases to boost interest in primary care, the report offers a number of recommendations for medical schools. Among them are that medical schools should develop accountable mission statements and reform their admissions processes to favor students who are more likely to go into primary care.

FPs Active in Developing COGME Report

Four family physicians served on the Council on Graduate Medical Education, or COGME, at the time the council's 20th report, Advancing Primary Care, was written.

Russell Robertson, M.D., professor and chair of the department of family and community medicine at the Feinberg School of Medicine, Northwestern University, Chicago, is currently the council's chair. He will become vice president of medical affairs at the Rosalind Franklin University of Medicine and Science, North Chicago, Ill., and dean of its Chicago Medical School effective March 1.

The COGME vice chair at the time was Robert Phillips Jr., M.D., M.S.P.H., director of the AAFP's Robert Graham Center in Washington, D.C.

Other family physicians who helped develop the report are Joseph Hobbs, M.D., professor and chair of the department of family medicine and senior associate dean for primary care and community affairs of the School of Medicine at the Medical College of Georgia in Augusta, and Jerry Kruse, M.D., M.S.P.H., professor and chair of the department of family and community medicine of Southern Illinois University School of Medicine in Springfield.

For GME programs, the report recommends training residents in outpatient settings; increasing primary care GME positions; providing GME funding directly to primary care residency programs; and encouraging more educational collaboration between academic programs and federally qualified health centers, rural health centers and the National Health Service Corps.

Changes Could Happen Quickly

Robert Phillips Jr., M.D., M.S.P.H., director of the Robert Graham Center and vice chair of COGME when the report was produced, told AAFP News Now that all five challenge areas include elements that could be changed quickly.

He cited as examples selective increases in primary care Medicare payments, financial support for quality improvements focused on primary care functions, and support for the patient-centered medical home, or PCMH.

In addition, said Phillips, modifying medical school admissions criteria to favor students who are more likely to go into primary care could happen quickly. Other measures that could be implemented swiftly are creating accountability measures for GME that take primary care production into account, increasing Title VII funding and creating more incentives for optimal physician distribution.

These options "could happen in the next Congress or by action of the administration," he said. In fact, some of these recommendations already are being addressed in the Patient Protection and Affordable Care Act.

However, Phillips said, reducing the income gap remains the most important recommendation for family physicians, and the mechanisms for doing so -- increases in fee-for-service, bundled payments, and financial rewards for care coordination and improvements in meeting performance measures -- move physician practices toward the PCMH model of care.