Medical Education Futures Study
George Washington University School of Public Health and Health Services
Josiah Macy Jr. Foundation
|Primary Care
Primary care physicians provide comprehensive health services including preventive care, early diagnosis and chronic disease management, as well as the diagnosis and treatment of acute medical problems. Yet, segments of the nation's population have limited or no access to primary care physicians, and the trend in recent years has been for medical school graduates to enter specialty fields over primary care fields.
As medical education enters a new era of expansion, this problem is likely to exacerbate without a long-term plan promoting the recruitment of students inclined to primary care, enhancing students' clinical experiences in primary care settings, and increasing the number of primary care residency positions.
Archive »Policy Briefs
POLICY PERSPECTIVE: The Outcomes of Implementing Patient-Centered Medical Home Interventions: A Review of the Evidence on Quality, Access and Costs from Recent Prospective Evaluation Studies
August 2009 - UCSF Center for Excellence in Primary Care
"Abundant research comparing nations, states and regions within the US, and specific systems of care has shown that health systems built on a solid foundation of primary care deliver more effective, efficient, and equitable care than systems that fail to invest adequately in primary care. However, some policy analysts have questioned whether these largely cross-sectional, observational studies are adequate for making inferences about whether implementing major policy interventions to strengthen primary care as part of health reform would in the relatively short term 'bend the cost curve' at the same time as improving quality of care and patient outcomes." Read More...
Graduate Medical Education: The Key to the Future of Primary Care?
"A growing and aging population, the prospect of expanded health care coverage, and strategies to mitigate the rising cost of health care all point to a need for more primary care physicians. The GME trends documented here, abetted by current Medicare GME policy, indicate fewer primary care physicians will be entering the workforce at a time when more are needed." Read More...
Medical Education Expansion and the Future of Primary Care
Evidence shows primary care is associated with improved quality, decreased costs, and better outcomes in health systems. However, recent trends in residency selection show young physicians are moving away from primary care. Family medicine programs are filling 15% fewer first year residency positions than 10 years ago with less than 50% of these positions filled by U.S. medical school graduates. Read More...
Archive »Research
Access Assured: A Pilot Program to Finance Primary Care for Uninsured Patients Using a Monthly Enrollment Fee
May/June 2010 – Journal of the American Board of Family Medicine
"A retainer-based program to enroll uninsured patients being used in 2 academic family medicine clinics attracted 600 patients during its first year. The program was financially viable and resulted in an expansion of our service to uninsured patients. More than half of the patients had incomes above 400% of the FPL, suggesting that the population of uninsured Oregonians may be economically more diverse than suspected." Read More...
Policy Challenges in Building the Medical Home: Do We Have a Shared Blueprint?
May/June 2010 – Journal of the American Board of Family Medicine
"Since 2007 the concept of the medical home has gained increasing attention in health care reform debates. Our findings suggest that translating this concept into successful, widespread reform will require that policymakers build further consensus among key stakeholders and require them to address critical barriers to avoid repeating pitfalls of past reform efforts." Read More...
Program Requirements For Residency Education In Family Medicine: Incremental vs Reformative Change
May/June 2010 – Annals of Family Medicine
"As we have seen, the wide regional variation in terms of practice patterns and community needs requires both flexibility within our training settings and different emphases in the types of competencies that are necessary for successful practice. This will likely only increase if and when we move into health care reform and the new era of primary care and practice transformation. Having said this, an emphasis on a proven set of core competencies which can be measured not only throughout residency, but throughout one's practice life is essential to assuring that family medicine is seen as a discipline of competency and high quality." Read More...
Primary Care Physician Supply and Children's Health Care Use, Access and Outcomes: Findings from Canada
June 2010 - Pediatrics
"Under universal insurance there are differences in access to, and outcomes of, primary care related to local physician supply after controlling for neighborhood income. The most pronounced effect is on primary and ED care use, but there are implications for acute and chronic disease control. Physician distribution is a critical issue to address in policies to improve access to care." Read More...
Development and Implementation of Training for Interdisciplinary Research in Primary Health Care
June 2010 – Academic Medicine
"The authors describe a national training program in Canada focusing on research in primary health care (PHC)." Read More...
Academic Retainer Medicine: An Innovative Business Model for Cross-Subsidizing Primary Care
June 2010 – Academic Medicine
"In 2004, the Department of Medicine at Tufts Medical Center developed an academic retainer-medicine primary care practice within the Division of General Medicine that not only generates financial support for the division but also incorporates a clinical and business model that is aligned with the mission and ethics of an academic institution…this unique business model addresses several of the ethical issues associated with traditional retainer practices—it does not restrict net access to care and it neutralizes concerns about patient abandonment. Addressing the growing primary care shortage, the model also presents the opportunity for a retainer practice to cross-subsidize the expansion of general medicine in an academic medical setting." Read More...
Primary Care Specialty Choices of United States Medical Graduates, 1997-2006
June 2010 – Academic Medicine
"Generalist-primary care specialty choices declined since 1997, whereas primary care subspecialty and no-board-certification specialty choices increased. Associations between primary care specialty choices and demographic, attitudinal, and career intention variables can inform the design of interventions to address expected primary care workforce shortages." Read More...
Using Evidence to Inform Policy: Developing a Policy Relevant Research Agenda for the Patient-Centered Medical Home
June 2010 – Journal of General Internal Medicine
"This editorial…calls for a research agenda to accompany the implementation of patient-centered medical homes. While previous research has focused on the importance of enhanced primary care, there has been little work to examine the feasibility of implementing the patient-centered medical home in the current U.S. health care system." Read More...
Defining and Measuring the Patient-Centered Medical Home
June 2010 – Journal of General Internal Medicine
"Transforming a medical practice into a PCMH, they say, requires a focus on the fundamental tenets of primary care, new ways of organizing care, the development of internal capabilities, and changes in reimbursement." Read More...
How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?
June 2010 – Journal of General Internal Medicine
"For a primary care practice to become a medical home, radical changes are needed not simply in health care delivery, but in other areas like patient engagement, office infrastructure, and billing and reimbursement." Read More…
Medical Students' Attitudes Towards Underserved Populations: Changing Associations with Choice of Primary Care Versus Non-Primary Care Residency
May 2010 – Journal of Health Care for the Poor and Underserved
"The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists." Read More…
Policy Challenges in Building the Medical Home: Do We Have a Shared Blueprint?
May 2010 – Journal of the American Board of Family Medicine
"The notion of a patient-centered medical home features prominently in policy reform initiatives across the country, with both state and federal legislation focusing on this new model. We sought to understand the views of key stakeholders and to examine the challenging landscape facing policymakers and practitioners as they attempt to translate the medical home concept into widespread practice change. Read More…
What's Keeping Us So Busy in Primary Care? A Snapshot From One Practice
April 29, 2010 – New England Journal of Medicine
"Primary care practices typically measure productivity according to the number of visits, which also drives payment. Work that does not involve a visit from a patient is invisible to those who support and purchase primary care. Several studies have estimated the amount of time that primary care physicians devote to nonvisit work. To provide a more detailed description, my colleagues and I used our electronic health record to count units of primary care work during the course of a year." Read More…
Health Care Reform and Primary Care – The Growing Importance of the Community Health Center
April 29, 2010 – New England Journal of Medicine
During the debate over U.S. health care reform, relatively little attention was paid to the long established network of community health centers (CHCs) in the United States. And yet this unique national asset constitutes a critical element of any reform intent on expanding access to health care through a primary care portal. Read More…
How Special is Family Medicine?
March/April 2010 – Annals of Family Medicine
"Where, oh where have all the family doctors gone? In recent years, the number of US seniors choosing to train in primary care fields has declined. A major driver of this drop is the increased numbers of internal medicine and pediatric senior residents selecting to pursue fellowship training after residency. The enticement of higher income and prestige that accompanies subspecialization is a strong motivator in many cases." Read More…
Greater NIH Investment in Family Medicine Would Help- Both Achieve Their Missions
March 2010 – Robert Graham Center
"Family medicine is the predominant provider of primary health care in the United States, yet it receives relatively little research funding from the National Institutes of Health (NIH). Family medicine can help the NIH speed research discovery and improve research relevance; the NIH can help family medicine build its research capacity, and such mutual benefit could mean improvement in public health." Read More…
Does Graduate Medical Education Also Follow Green?
February 22, 2010 – Archives of Internal Medicine
In his 2008 research letter, Ebell1 highlights the relationship between residency fill rates and physician specialty salary. Mullan referred to this as the 'white-follows-green law.' In the hope of informing these concerns that hospitals may be responding to financial incentives over workforce needs in their allocation of GME positions, we explored the relationship between physician income and 10-year growth in primary care residency positions vs those in a group traditionally noted for their 'lifestyle' appeal and higher likelihood of driving hospital revenues." Read More…
Harnessing Geographic Information Systems (GIS) to Enable Community-Oriented Primary Care
January 2010 – Journal of the American Board of Family Medicine
"Despite growing acceptance and implementation of geographic information systems (GIS) in the public health arena, its utility for clinical population management and coordination by leaders in a primary care clinical health setting has been neither fully realized nor evaluated." Read More…
Rural Idaho Family Physicians' Scope of Practice
Winter 2010 – Journal of Rural Health
"Rural areas experience significant challenges in recruiting and retaining family physicians. The number of rural family physicians has been declining in contrast to the increasing health care needs among rural residents, who tend to be older, sicker, poorer, less educated, and living without health insurance. These challenges can materially impact local community access to health care, both for general medical care and for specific medical services such as obstetrics and emergency services. Considering the current and projected declining trends in family physicians and an increase in the number of elderly citizens, the United States must increase the number of family physicians, especially in rural areas, in order to provide adequate care to residents." Read More…
Just What Are Rural Premedical Students Thinking? A Report of the First 6 Years of a Pathways Program
Winter 2010 – Journal of Rural Health
"A severe, long-lasting shortage of physicians has been predicted, and this will be most severe in rural areas. Most medical schools are reacting to this by increasing class size, often as much as 30%. If present premedical education and admissions policies continue, however, the majority of the new physicians will locate in urban areas, with negligible effect on the majority of underserved Americans. A few programs have produced small numbers of rural physicians by changing admissions policies and having special programs for premedical students from underserved areas, those most likely to return to similar areas. Put simply, the most effective way to change the maldistribution of physicians is to admit the kind of students to medical school who are not currently achieving admission." Read More…
An Idea Whose Time Has Come?
January 21, 2010 – Annals of Internal Medicine
"The timely article 'Addressing the Primary Care Workforce Crisis for the Underserved' by Rieselbach, Crouse, and Frohns (Dec. 14th) highlights the urgent workforce shortage in Community Health Centers (CHCs) and the increasing interest in the "Health Center" (THC) concept. Current language in the health reform bill provides funding for support and creation of THCs as a potential solution to the workforce for the underserved." Read More…
Allies in Family Medicine Advocacy: The Patient-Centered Primary Care Collaborative
January 2010 – Annals of Family Medicine
"In 2005, IBM recognized that the health care it purchased was costly and of poor quality, mainly because there were no incentives for the provision of continuous, longitudinal care. In 2006, large employers led by IBM organized a coalition of consumer groups, quality organizations, health plans, labor unions, and physician groups to advance the principles of the Patient-Centered Medical Home (PCMH) and advocate for a model of health care compensation with the appropriate incentives. This coalition was named the Patient-Centered Primary Care Collaborative (PCPCC)." Read More…
Generating the Knowledge Needed to Make the Patient-Centered Medical Home a Reality: A Collaborative Project of the Primary Care Specialties
January 2010 – Annals of Family Medicine
"There is a clear consensus that primary care needs to be at the center of a reformed US health care system. The Patient-centered Medical Home (PCMH) has emerged as the key strategy for the redesign of primary care. The PCMH model builds upon the core concepts of primary care that include accessible, accountable, coordinated, comprehensive, and continuous care in a healing physician-patient relationship over time. Added to these basic primary care concepts are features that improve quality of care, improve patient centeredness, organize care across teams, and reform the payment system to support this enhanced model of primary care." Read More…
FaMeS: An Innovative Pipeline Program to Foster Student Interest in Family Medicine
January 2010 – Family Medicine
"There is a national shortage of primary care physicians; many medical school departments of family medicine are searching for new ways to attract and retain students who may be interested in primary care. In 2004, our department began a "pipeline" program targeted at entering first-year students that incorporates curricular, extracurricular, summer, and career-planning elements." Read More…
Changes in the Knowledge of and Attitudes Toward Family Medicine After Completing a Primary Care Course
January 2010 – Family Medicine
"The study's objective was to determine medical students' knowledge of and attitudes toward family medicine before and after completing a course in primary care. After completing the course, the students showed an improvement in their knowledge of and attitudes toward family medicine and primary care, but only a small percentage considered a career in family medicine as a first-choice option." Read More…
Addressing the Primary Care Workforce Crisis for the Underserved
December 14, 2009 – Annals of Internal Medicine
"Universal coverage and multiple initiatives to improve health care delivery are crucial components of health care reform. However, the missing link has been a plan to rapidly address the primary care workforce crisis for the underserved. This can be achieved by establishing primary care teaching health centers in expanded community health centers, which have established a patient-centered medical home practice environment." Read More…
Persistent Primary Care Health Professional Areas (HPSAs) and Health Care Access in Rural America
September 2009 - WWAMI Rural Health Research Center
"This study examines the degree to which persistence of primary care HPSA designation in rural counties is associated with lower population socioeconomic status and deficiencies in access to health care services." Read More…
Redesign of the Health Care Delivery System: A Bauhaus "Form Follows Function" Approach
December 3, 2009 – Journal of the American Medical Association
"The governing design principle of the US health care system has been described as an 'edifice complex' and a 'field of dreams' complex—if the health system builds it, the patients will come. This clinician-centric approach to the design of delivery of health care is obsolete, contributing to health care of inferior quality and excessive cost. To meet the patient-centered needs of a modern health care system, the United States should consider adopting the Bauhaus design principle of 'form follows function.'" Read More…
A Survey of Primary Care Physicians in Eleven Countries, 2009: Perspectives on Care, Costs and Experiences
November 2, 2009 – Health Affairs
"In many countries, primary care clinicians serve as the foundation for health care and the "gatekeepers" for more specialized referrals. A new international survey of primary care physicians in eleven countries finds that American doctors are significantly behind many of their counterparts elsewhere in providing access to high-quality care and use of health information technology." Read More…
Self Directed Community Health Assessment Projects in a Required Family Medicine Clerkship: An Effective Way to Teach Community Oriented Primary Care
November/December 2009 – Family Medicine
"Community-oriented primary care (COPC) is a key teaching objective of many medical school family medicine clerkships. Though many programs are in place, little is published evalu¬ating the effectiveness of curricula." Read More…
The Primary Care Crisis and Health Care Reform
November 2009 – Journal of Healthcare for the Poor and Underserved
"Health care reform must ensure that our workforce is able to meet the demands of delivering primary care to patients. Program funding, financing mechanisms and incentives, and implementing infrastructure changes are all needed to ensure that clinicians are attracted to primary care, faculty are in place to educate health care professionals, and health care delivery is efficient and effective. Ameliorating the problems presently impeding primary care delivery involves more than just training additional doctors to become primary care physicians." Read More…
Training Residents in Community Health Centers: Facilitators and Barriers
November/December 2009 – Annals of Family Medicine
"Family medicine residencies (FMRs) and Community Health Centers (CHCs) are confronted with 2 different aspects of the current primary care workforce crisis in the United States. FMRs suffer from declining student interest in primary care and perennial threats to financial solvency. Training family medicine residents in underserved settings, such as community health centers (CHCs), may provide a solution to the primary care workforce shortage. We sought to describe the facilitators and barriers to creating partnerships between CHCs and family medicine residencies (FMRs)." Read More…
Ensuring Progress in Primary Care – What Can Health Care Reform Realistically Accomplish?
October 28, 2009 – New England Journal of Medicine
"Despite the apparent agreement on reforming primary care, there is no assurance that the health care reform bills currently under debate will make these consensus-based recommendations a reality. Primary care has thus far taken a back seat to the more contentious elements of the health care reform bills, such as methods of expanding insurance coverage, the institution of individual and employer mandates, financing strategies, and medical malpractice reform. In terms of augmenting the primary care workforce, the House bill is more robust than the Senate bills. Both houses would redistribute currently unused medical residency slots in favor of training for primary care practitioners. Both would also fund "teaching health centers," or ambulatory-based primary care training in, for instance, community health centers." Read More…
Primary Care and Accountable Care – Two Essential Elements of Delivery-System Reform
October 28, 2009 – New England Journal of Medicine
"With discussions about U.S. health care reform focused heavily on insurance reforms, relatively little attention has been paid to the delivery-system reforms that will be required to improve the quality and coordination of health care and slow the growth of spending. The "patient-centered medical home" (PCMH) and the "accountable care organization" (ACO) are two widely discussed models for delivery-system reform that take complementary approaches to achieving these goals." Read More…
Aspects of the Patient Centered Medical Home Currently in Place: Initial Findings from Preparing the Personal Physician for Practice
Patricia A. Carney, PhD et al., Family Medicine, October 2009
"The Patient-centered Medical Home (PCMH) is advo¬cated as an important element of health reform based on evidence of improved patient outcomes in primary care at lower cost.1-7 One study found that US states that relied more on primary care have lower Medi¬care spending, lower resource use, lower utilization rates, and better quality of care, as measured by fewer intensive care deaths and a higher composite quality score." Read More…
Physician Assistants and Nurse Practitioners as a Usual Source of Care
Chrisinte M. Everett, MPH PA-C et al., Journal of Rural Health, September 23, 2009
"The United States (US) is faced with an aging population, projected physician shortages, and an increase in the prevalence of chronic disease, health care costs, and the number of uninsured Americans, making access to health care a leading policy issue. Since 1967, non-physician providers such as Physician Assistants (PAs) and Nurse Practitioners (NPs) have been utilized to improve access and reduce health care costs. Approximately 110,000 PAs and NPs currently practice in the United States. Fifty percent of PAs and 85% of NPs practice in primary care and are more likely than doctors to practice in rural areas and with underserved populations." Read More…
Innovation Networks: A Strategy to Transform Primary Health Care
Peter Margolis, MD PhD and Neal Halfon, MD MPH, Journal of the American Medical Association, October 7, 2009
"Upgrading primary care is key to realizing the promise of health care reform to improve access and quality while reducing costs. Promising models, such as the patient-centered medical home and new measurement systems for detecting better population outcomes, require primary care clinicians to develop innovative ways of organizing care. Because new and improved approaches are not easily transplanted directly into practice, transforming primary health care will be virtually impossible without a system for innovating, testing, and providing what works. Primary health care innovation networks can accelerate primary care transformation by harnessing the collective intelligence and motivation of the medical community." Read More…
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians
September 23/30, 2009 – Journal of the American Medical Association
"Primary care physicians report alarming levels of professional and personal distress. Up to 60% of practicing physicians report symptoms of burnout, defined as emotional exhaustion, depersonalization (treating patients as objects), and low sense of accomplishment. Physician burnout has been linked to poorer quality of care, including patient dissatisfaction, increased medical errors, and lawsuits and decreased ability to express empathy. The consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the stability of the physician workforce." Read More…
British Lessons on Health Care Reform
September 24, 2009 – New England Journal of Medicine
"So what can the United States learn from the NHS? The jewel in the NHS crown is the strength of its primary care and its general practitioners. These highly trained physicians contribute to Britain's health by focusing on the health of the whole person, rather than on a single organ; emphasizing prevention and health screening, which should reduce the life-expectancy gap between rich and poor, currently about 13 years in Britain; acting as gatekeepers, who control costs by referring only patients who truly require a specialist's opinion, since 86% of medical needs can be managed in the community; and providing continuity and coordination of care and being patients' constant companions in the domain of health care." Read More…
American Recovery and Reinvestment Act and the Expansion and Streamlining of the National Health Service Corps: A Great Opportunity for Service-Minded Family Physicians
Journal of the American Board of Family Medicine, September 2009
"President Obama has challenged Americans to improve their communities and country through service to others. There are many ways one can serve others but few ways one can do this and benefit financially from one's service. The National Health Service Corps (NHSC) offers physicians and others in health care a way to do exactly this. With a $300 million expansion from the American Recovery and Reinvestment Act and an updating of its programs, the NHSC now offers more and better opportunities than ever for rewarding and well-compensated service." Read More…
American Medical Home Runs
Health Affairs, September/October 2009
"Four primary care sites in the United States constitute "medical home runs" because their patients incur 15–20 percent less (risk-adjusted) total health care spending per year than patients treated by regional peers, without evidence of reduced quality. The sites achieved this result in a U.S. payment environment that usually penalizes physicians who invest to prevent costly near-term health crises. If the ingredients and accomplishments of these four sites spread, under- and uninsured lower-income Americans could be fully covered in the foreseeable future without increased health spending or lower quality of care. In exchange, sponsors of health benefits would gladly support additional primary care physician payment." Read More…
The PCMH: A Model for Primary Care
Journal of the American Academy of Physician Assistants, September 16, 2009
"The concept of the patient-centered medical home (PCMH) was developed by primary care physicians and large employers to encourage comprehensive health care, improve patient outcomes, and lower medical costs. The PCMH approach provides comprehensive care in a setting that facilitates a partnership with the patient, via an interdisciplinary healthcare team and community resources. The current goals of the PCMH include providing high-quality preventive care and effective chronic disease management across the life span and a reimbursement structure that includes coverage for coordination of care and documentation of patient outcomes." Read More…
The End of Fee-For-Service Medicine? Proposals for Payment Reform in Massachusetts
New England Journal of Medicine, September 10, 2009
"Health care reform has multiple goals, including expanding insurance coverage, improving quality and access to care, and controlling costs. Since Massachusetts enacted reforms in 2006, the proportion of residents lacking health insurance has decreased to an estimated 2.6% — the lowest of any state. However, there are continuing concerns about quality and access, and health care costs per capita remain among the highest in the United States. A special commission has therefore proposed that Massachusetts effectively end fee-for-service medicine, the predominant form of payment for health care services, and replace it with a system of global payments that combines the approaches of risk-adjusted capitation and pay for performance with a strong focus on primary care." Read More…
Entry of US Medical School Graduates Into Family Medicine Residencies: 2008-2009 and 3-Year Summary
Family Medicine, September 2009
This is the 28th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. Approximately 8.2% of the 16,336 graduates of US medical schools between July 2007 and June 2008 were first-year family medicine residents in 2008, compared with 8.3% in 2007 and 8.5% in 2006. Medical school graduates from publicly funded medical schools were more likely to be first-year family medicine residents in October 2008 than were residents from privately funded schools, 9.8% compared with 5.6%." Read More…
Results of the 2009 National Residency Matching Program: Family Medicine
Family Medicine, September 2009
"The results of the 2009 National Resident Matching Program (NRMP) reflect a persistently low level of student interest in family medicine residency training in the United States. Compared with the 2008 Match, 70 fewer positions (with 89 fewer US seniors) were filled in family medicine residency programs through the NRMP in 2009, at the same time that 18 fewer positions were filled in primary care internal medicine (11 fewer US seniors), one more position was filled in pediatrics-primary care (three more US seniors), and 13 more positions were filled in internal medicine-pediatrics programs (but with seven fewer US seniors)." Read More…
Primary Care Remuneration – A Simple Fix
Arthur Fournier, MD, The New England Journal of Medicine, August 19, 2009
"Fixing primary care is critical to health care reform but will require simultaneously fixing several problems, including those related to remuneration, the work environment, and medical education.1 The most critical of these issues is remuneration." Read More…
The Paradox of Primary Care
July/August 2009 – Annals of Family Medicine
"Despite rising costs, health care often is of poor quality. Current solutions to improving quality may do more harm than good if they focus more on diseases than on people. Primary care is touted as an essential building block of a high-value health care system even as it is undermined by systems attempting to improve the quality, effectiveness, and value of their health care. These contradictions plague improvement efforts in health care systems around the world, particularly the United States." Read More…
The Political Economy of U.S. Primary Care
July/August 2009 – Health Affairs
"Compelling evidence suggests that the United States lags behind other developed nations in the health of its population and the performance of its health care system, partly as a result of a decades-long decline in primary care. This paper outlines the political, economic, policy, and institutional factors behind this decline. A large-scale, multifaceted effort—a new Charter for Primary Care—is required to overcome these forces. There are grounds for optimism for the success of this effort, which is essential to achieving health outcomes and health system performance comparable to those of other industrialized nations." Read More…
The Uncertain Future of Primary Medical Care
David Mechanic, PhD, Annals of Internal Medicine, July 7, 2009
"The United States needs a strong primary medical care capacity as we engage the challenges of health care reform, expand insurance coverage, and constrain medical costs without sacrificing quality. Research over decades has repeatedly demonstrated that primary care services that provide continuing access to care are associated with superior population health outcomes. Nonetheless, the future of U.S. primary care is uncertain, many clinicians report high levels of frustration and dissatisfaction, and careers in primary care are increasingly unattractive to new medical graduates." Read More…
Working Conditions in Primary Care: Physicians Reactions and Care Quality
Mark Linzer, MD et al, Annals of Internal Medicine, July 7, 2009
"The primary care workplaces we studied involve many challenges for practicing physicians. Work conditions, including workflow (time pressure and a chaotic work pace), job characteristics (lack of work control), and poor organizational culture were strongly associated with adverse physician reactions. Our findings may explain current difficulties in recruiting and retaining primary care physicians but leave open the question of whether adverse work conditions influence health care quality and safety." Read More…
Easing the Shortage in Adult Primary Care – Is It All About Money?
Robert Steinbrook, MD, New England Journal of Medicine, June 25, 2009
"As Americans debate health care reform, it is easy to forget that success may depend as much on the availability of primary care physicians for adults as on the specifics of the reforms themselves. Access to health insurance does not ensure access to timely medical care, particularly in places where doctors are in short supply, are not accepting new patients, or are not accepting patients with some types of insurance. Effective primary care can improve the quality of care and health outcomes and save money. But to the extent that easing the shortage of primary care physicians will require additional funds, the initial costs of reform will increase." Read More…
A Lifeline for Primary Care
Thomas Bodenheimer, MD, Kevin Grumbach, MD and Robert Berenson, MD, New England Journal of Medicine, June 25 2009
"Primary care in the United States needs a lifeline. In 2009, for the 12th straight year, the number of graduating U.S. medical students choosing primary care residencies reached dismally low levels.1 Overloaded primary care practices, whose doctors are aptly compared to hamsters on a treadmill, struggle to provide prompt access and high-quality care. Three major factors contribute to this crisis." Read More...
A Health Care Cooperative Extension Service: Transforming Primary Care and Community Health
Kevin Grumbach, MD and James W. Mold, MD MPH, Journal of the American Medical Association, June 25, 2009
Primary care is the essential foundation for an effective, efficient, and equitable health care system. Calls to rebuild the crumbling primary care infrastructure in the United States are reaching receptive ears, with public and private advisory groups including the Medicare Payment Advisory Commission and the National Business Group on Health recommending increased payments for primary care. Policy makers expect that new investments will transform primary care by creating more effective and efficient patient-centered medical homes. The primary care physician community acknowledges the need for new practice models that provide accessible, comprehensive, integrated care based on healing relationships over time." Read More…
The Demise of Primary Care: A Diatribe From the Trenches
David D. Norenberg, MD, Annals of Internal Medicine, May 17, 2009
"Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality—simplistically defined as dogmatic adherence to a standard. Individualized clinical judgment has been devalued; thinking has been replaced by algorithms. Generalists are spending so much time proving they are good doctors, they don't have time to be good doctors." Read More…
Commentary: Grow the National Health Service Corps
Jonathan Saxton MD and Micheal Johns MD, Journal of the American Medical Association, May 13, 2009
"President Barack Obama has called for the renewal and expansion of volunteerism and national service so that citizens everywhere can help address serious national challenges. This call has been embraced across the country and even across party lines. Both the US House of Representatives and the US Senate have responded with bipartisan legislation designed to encourage such service. This broad initiative presents the health professions with an extraordinary opportunity to renew health professions' basis in charity while modeling service, wellness, and chronic care programs essential to health care reform. The National Health Service Corps (NHSC) could be the best place to start." Read More…
Commitment to Care for the Community
Catherine DeAngelis MD, Journal of the American Medical Association, May 13, 2009
"With the variety of proposed solutions to the problem of so many Americans not having access to care, in this case primary care, the common theme is commitment to care for the community. This includes commitment by physicians and other clinicians to provide the kind of care they know is best for patients, commitment by all payers—private or public—to provide the resources needed for this care, and commitment by patients to pay for what they can and not to misuse the system that provides care for them. Some individuals might believe this effort to be a pipe dream, but without the commitments by all those involved, there will never be a health system in the United States to care for all who truly need it." Read More…
Commentary: Oversimplifying Primary Care Supply and Shortages
Gary Freed MD MPH and James Stockman MD, Journal of the American Medical Association, May 13, 2009
"Attempting to ensure an appropriate primary care workforce to meet the needs of the United States is a complex and daunting task that is vital to the ultimate health of the nation. Oversimplifying the nuances of the primary care workforce may result in policies and priorities at odds with needs. For the specialty of pediatrics, it appears that a close to appropriate proportion of trainees continues to enter the primary care arena. Certainly, an erosion of that proportion or in the absolute number of physicians entering pediatrics would require appropriate action to ensure a continued capacity to provide general and subspecialty care to children. Those concerned with workforce adequacy should continue to monitor the situation closely." Read More…
Toward International Primary Care Reform
Barbara Starfield, MD MPH, Canadian Medical Journal, May 26, 2009
"Primary care reform is now a worldwide imperative. National health care systems with strong primary care infrastructures have healthier populations, fewer health-related disparities and lower overall costs for health care. In the World Health Organization's 2008 World Health Report, all countries were encouraged to orient their health care systems toward strengthened primary care. Such reforms are unlikely to improve overall population health, equalize distribution of health care resources or reduce costs unless they address both the systemic and clinical characteristics of primary care." Read More…
Community Dimensions and HPSA Practice Location: 30 Years of Family Medicine Training
Suzanne B. Cashman, ScD et al. Family Medicine, April 2009
"In 1996, the Institute of Medicine revised the definition of primary care to include "the community context of medical practice." Shortly after, as a way to move beyond the general sentiment that community should factor into a physician's work, Pathman et al identi¬fied and defined four distinct categories of activities (sociocultural aspects of patient care, use of commu¬nity health resources, community-oriented primary care, and community participation and assimilation) through which physicians engage with communities. This framed much of the last decade's discussion about and exploration into physicians' community involvement." Read More…
Ambulatory Care Provided by Office-Based Specialists in the United States
Annals of Family Medicine - March/April 2009
"This profile of the more than 1 billion ambulatory visits to office-based specialists in 2002 through 2004 showed a considerable variation across physician specialties in the patient and visit profiles, but clear patterns emerged. Routine and preventive care for patients already known to the physician accounted for one-half of visits, and most of these visits resulted in a subsequent appointment with the same physician. Referrals by other professionals accounted for less than one-third of all specialty care visits, with patients having been referred for a variety of different visit types. For patients without a referral, specialists had one-third the odds of sharing the patient's care with another physician." Read More…
How Can Primary Care Cross the Quality Chasm?
Annals of Family Medicine - March/April 2009
"The chasm between knowledge and practice decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed. They include the chasm between what we know and what we need to know to improve care; the chasm between those who provide primary care and those who do not fund, study, support, or publish practical primary care studies; and the chasm between research and quality improvement (QI). If we are to facilitate the production and use of the knowledge needed for primary care to cross IOM's chasm, major changes are needed." Read More…
Patient-Physician Connectedness and Quality of Primary Care
Annals of Internal Medicine - March 3, 2009
"Persistent deficiencies exist in the quality of health care in the United States. Because primary care physicians are the first source of health care for most patients to receive preventive and chronic illness care, efforts to measure and improve quality of care have often focused on these physicians. In practice, however, many patients receive episodic care from different physicians. Patients without a regular source of care are less likely to receive care consistent with guidelines." Read More…
Medical Students, Money, and Career Selection: Students' Perception of Financial Factors and Remuneration in Family Medicine
Dante J. Morra, MD MBA et al, Family Medicine, February 2009
"Despite the importance of family physicians to the health care system and the numerous training opportunities that exist in the field, medical students' interest in primary care has decreased. Residency positions are frequently left vacant as there is a migration by medical students to more-specialized career paths. Although there is no one variable that determines medical student career selection, studies have suggested that financial factors may influence career choice." Read More…
Primary Care: Too Important to Fail
David S. Meyers MD and Carolyn M. Clancy MD, Annals of Internal Medicine, February 17, 2009
"The U.S. primary care system is struggling. Increasing demands and expectations, coupled with diminishing economic margins, have created a challenging work environment. As the new Obama administration arrives in Washington, policy prescriptions for health care reform are being dispensed from every side. Many of them emphasize the importance of revitalizing the nation's primary care system. As a foundational element of the health care system, primary care is needed to improve quality, increase access, and contain costs. These are the principal goals of health care reform." Read More…
Primary Care Physicians' Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination
Hoangmai Pham, MD MPH et al, Annals of Internal Medicine, February 17, 2009
Coordination of care involves the integration of care across all of a patient's conditions and needs, across providers and settings, and in accordance with the preferences and capabilities of patients and their families. Coordination involves complex activities that require conscious interactions between providers and between providers and patients, including timely transfer of accurate clinical information, effective communication between the involved parties, and shared decision making. Primary care physician societies advocate support for the "advanced medical home," conceived as a physician-directed practice that provides coordinated, accessible, continuous, and comprehensive care. Read More...
Archive »Reports
Report to Congress: Aligning Incentives in Medicare
June 2010 – MedPAC
"Despite the tremendous advances that our GME system has brought to modern health care, the Commission finds it is not consistently producing physicians and other health professionals who can become leaders in reforming our delivery system to substantially improve its quality and value. Two specific areas of concern are workforce mix—including trends in specialization and limited socioeconomic diversity—and education and training in skills needed for improving the value of our health care delivery system—including evidence-based medicine, team-based care, care coordination, and shared decision making." Read More...
Strengthening Primary Care to Bend the Cost Curve: The Expansion of Community Health Centers Through Health Reform
June 30, 2010 – The George Washington University
"The recent enactment of health reform sets into motion important changes that will expand health insurance coverage, increase funding for community health centers and alter the way that health centers are paid. These reforms will have a major impact on two major challenges of health reform: bolstering the capacity of the nation's primary care system and reducing the long term growth in health care costs." Read More…
US Approaches to Physician Payment: The Deconstruction of Primary Care
May 27, 2010-The Urban Institute
"The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion." Read More...
Promoting Appropriate Payments for the Value Provided by Primary Care and Care Coordination
May 2009 – Center for Payment Reform
"Payment reforms must recognize the value provided by primary care in managing the health of individuals and populations. We will not create a delivery system that is patient-centered and well-equipped to deliver high quality care while controlling costs without changing payments to recognize the value of care coordination and the management of patients, particularly those with complex chronic illnesses." Read More…
The Breadth of Primary Care: A Systematic Literature Review of Its Core Dimensions
March 13, 2010 – BMC Health Services Research
"Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level." Read More…
Who Will Provide Primary Care and How Will They Be Trained?
February 2010 – Josiah Macy, Jr. Foundation
"In January 2010 the Josiah Macy, Jr. Foundation convened a conference to address complex issues concerning who will provide primary care and how they will be trained. Participants developed the set of conclusions and recommendations found in this Executive Summary." Read More…
Remaking Primary Care: A Framework for the Future
January 2010 – Josiah Macy, Jr. Foundation
"As U.S. policymakers pursue major reform proposals to improve the quality and affordability of health care, primary care – the foundation of all care delivered in the United States – is in a state of crisis. Through this report, NEHI seeks to highlight the root causes of the crisis in primary care; identify innovations that could enhance its quality and efficiency; and explore changes required in the education of health professionals to better serve the practice of primary care." Read More…
State Multi-Payer Medical Home Initiatives and Medicare's Advanced Primary Care Demonstration
February 2010 – National Academy for State Health Policy
"Medical homes provide enhanced primary care in which care teams attend to the multi-faceted needs of patients, and provide whole person, comprehensive, ongoing, and coordi¬nated patient-centered care. Sometimes referred to as APC, many experts say the medical home model shows great prom-ise to improve the quality, accessibility, and value of health care in the United States." Read More…
Expanding the Primary Care Workforce: An Essential Element of Health Care Reform
November 2009 – Center for American Progress
"There are not enough primary care providers to meet current needs. We will need targeted policy changes to ensure that we are well-positioned to provide services to the additional millions of Americans who will have health insurance under health care reform. Massachusetts provides a case in point; the state passed universal coverage in 2008, and there is now concern that there are not enough basic health services providers to accommodate the newly insured. The main reason for this shortage is that medical students do not generally choose to work in primary care. This has been a longstanding and worsening issue; the number of medical school graduates entering family medicine residencies dropped by 50 percent between 1997 and 2005." Read More…
Using Primary Care to Bend the Cost Curve: The Potential Impact of Health Center Expansion in Senate Reforms
October 14, 2009 – The George Washington University
"In addition to expanding health insurance coverage, a critical challenge in health reform is investing in a health care delivery system that can foster long-term efficiencies and reduce the rate of growth in health care expenditures. Many have expressed this goal as "bending the curve" of health care costs. This brief report examines the impact of a health center expansion on both access in medically underserved areas and health care costs." Read More…
Title VII's Decline: Shrinking Investment in the Primary Care Training Pipeline
October 15, 2009 – The Robert Graham Center
"Title VII, Section 747 of the Public Health Services Act is intended to increase the quality, quantity, and diversity of the primary care workforce, with special emphasis on increasing capacity to care for the underserved. It supports the development of innovative primary care curricula and programming at the medical school, residency, fellowship, and departmental levels. Title VII is associated with increased primary care physician production and practice in underserved areas. Despite this, funding has declined since 1978." Read More…
Incremental Cost Estimates for the Patient-Centered Medical Home
October 16, 2009 – The Commonwealth Fund
"Over the past several years, there has been wide and growing interest in organizing primary care practices into "medical homes" (MHs), which provide care coordination, patient education, and related services in addition to primary medical care. Several prominent medical societies collaborated to articulate the "Joint Principles of the Patient-Centered Medical Home," core concepts that have been incorporated into the National Committee for Quality Assurance's (NCQA's) Physician Practice Connections–Patient-Centered Medical Homes (PPC-PCMH) recognition tool. But despite the attention being paid to the medical home approach, little is known about the costs associated with this practice model; the focus of most available studies is in establishing payment rates or value (by means of savings through reduced use of other services), not in providing clear cost estimates." Read More…
Family Physician Workforce Reform: Recommendations of the American Academy of Family Physicians
American Academy of Family Physicians, September 29, 2009
"The AAFP has sounded a clarion call in a new physician workforce reform report that recommends comprehensive changes in national workforce planning; specialty distribution; graduate medical education, or GME, funding; and medical education policy to secure a family physician and primary care workforce that meets the country's burgeoning needs." Read More…
Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs
The George Washington University, September 1, 2009
"This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform. Health insurance coverage expansions, coupled with investments in the nation's primary health care infrastructure, can spur high quality and sustainable primary health care in medically underserved rural, urban, and suburban communities, and help bend the curve of health care cost growth." Read More…
Decreasing Self-Perceived Health Status Despite Rising Health Expenditures
The Robert Graham Center, September 1, 2009
"Despite steady increases in U.S. health care spending, the population's self-perceived health status has been in a long-term decline. Increased support for public health, prevention, and primary care could reduce growth in spending and improve actual and perceived health. Continuing to spend more on our fragmented health care system is unlikely to change the pattern of high expenditures and suboptimal health. Countries that invest in comprehensive primary care systems have better health outcomes, patient satisfaction, uptake of preventive services, and lower mortality." Read More…
Community Health Centers in Indiana: State Investments and Returns
July 29, 2009 – The George Washington University School of Public Health and Health Services
"Investment in community-based health centers could save states millions of dollars a year, according to a new study 'Community Health Centers in Indiana: State Investments and Returns' conducted by faculty and staff at The George Washington University School of Public Health and Health Services. Though the report focused on community health centers in Indiana, the results have implications for all states." Read More…
Developing A Strong Primary Care Workforce
Josiah Macy, Jr. Foundation - April 2009
"On April 20, 2009, the Josiah Macy, Jr. Foundation convened a small meeting in Washington, DC that focused on the future of the nation's primary care workforce. Among those in attendance were individuals from four organizations with expertise in primary care and prevention. The participants expressed their concern that most of the health care reform discussion has focused on financial issues, with too little attention on the workforce that will provide health care. The group articulated seven recommendations that should be implemented to advance the health of the nation. The brief presents these recommendations with a discussion about the rationale for each."
To download a copy of the summary report, click here.
The Effect of Facilitation in Fostering Practice
The Robert Graham Center, June 2009
"Working with facilitation agents measurably improves the ability of motivated primary care practices to move towards improved models of care. Widespread primary care practice transformation will likely require facilitation capacity in most communities." Read More…
Effects of Proposed Primary Care Incentive Payments on Average Physician Medicare Revenue and Total Medicare Allowed Charges: A White Paper
The Robert Graham Center - May 2009
There is considerable concern about a future primary care physician shortage and potential constriction of access to primary care. In June 2008, MedPAC commissioners suggested that there may be a need to selectively boost primary care physician payment. In 2009 hearings regarding the physician workforce, members of the Senate Finance Committee also appeared willing to consider payment reform in support of primary care. On April 29, 2009 the Senate Finance Committee released a report on policy options for reform. The listed options include an incentive payment for primary care services for physicians who meet a threshold of 60% of services in outpatient settings. In this white paper, we model the current incentive proposal, other related options, and potential costs to Medicare. We then discuss impact, unintended consequences, and concerns." Read More…
Innovative Strategies to Increase and Sustain the Primary Care Workforce – Executive Summary
June 2009 – Family Medicine Education Consortium
"On October 31, 2008, the Family Medicine Education Consortium held a preconference forum titled Innovative Strategies to Increase and Sustain the Primary Care Workforce. This forum brought together thought leaders from health care systems, insurance companies, medical societies, policy centers, and academia. The purpose of the meeting was to generate discussion on a critical issue facing our current healthcare system throughout the nation – the lack of primary care providers serving our communities, and the negative impact that this is having on the quality and cost of healthcare." Read More…
Financing Community Health Centers as Patient- and Community-Centered Medical Homes: A Primer
The George Washington University - May 27, 2009
"This report shows that although health centers play a critical role in providing preventive and primary care for many uninsured and insured Americans who cannot afford health care, they face numerous payment policy challenges which could undermine their mission. Any effort to improve health care financing should not only incentivize high performance but also recognize and support fairly the higher burden of costs associated with medically vulnerable populations." Read More…
Solutions to the Challenges Facing Primary Care Medicine
American College of Physicians - April 2009
"The future of primary care is at great risk at a time when the evidence suggests that the nation needs primary care more than ever before. Studies at the state, county, and local level confirm that primary care improves health outcomes, increases quality, and reduces health care costs. Despite the availability of such evidence, the United States has done little to ensure that the supply of primary care physicians is sufficient to meet current and future needs." Read More…
Primary and Preventive Healthcare: A Critical Path to Healthcare Reform for Florida – The Role of Florida's FQHCs
The George Washington University School of Public Health - January 2009
"A strong system of primary health care that can assure all patients of a medical care home is a fundamental goal of any health reform initiative, whether state or federal. This analysis examines the importance of comprehensive primary care to Florida's health care system, and the foundational role played by the state's 42 Federally Qualified Health Centers (FQHC) in achieving this goal for its most vulnerable populations." Read More…
How Is the Primary Care Safety Net Faring in Massachusetts? Community Health Centers in the Midst of Health Reform
Kaiser Commission on Medicaid and the Uninsured - March 2009
"Because of the central role played by primary health care in a well-functioning health care system, an important policy question about health reform is the effect on primary health care access, capacity, and performance. The nature of this inquiry grows urgent in the case of medically underserved communities and populations at elevated risk for poorer health status, disparities in health and health care access, and a shortage of primary health care professionals. The nation's more than 1,000 federally and state-supported community health centers represent a principal source of primary care for medically underserved communities and populations, serving more than 16 million patients in 2007 at more than 6,000 sites." Read More…
American College of Physicians Releases State of the Nation's Health Care 2009 Report
American College of Physicians - February 2, 2009
"On February 2, 2009, at ACP's annual report on the state of the U.S. health care system we called on President Obama and Congress to take steps to improve health care by recognizing that primary care is the best medicine for better health and lower costs. As part of those steps, we recommended that President Obama issue an executive order to assure that all federal agencies are working together to set primary care workforce goals and the policies necessary to achieve those goals."
Click here to read the full report.
Click here to read the one-page summary of recommendations to fund primary care payment increases.
Nurse Practitioners in Primary Care
American College of Physicians - February 17, 2009
"Anticipated and actual shortages of primary care physicians have led policymakers to consider the roles of nurse practitioners (NPs) in improving access to primary health care services. Physicians and nurse practitioners not only share a commitment to providing high quality care, but also face similar challenges regarding reimbursement and workforce outlook. Recognizing and building on the common ground between the two professions is vital to improving collaboration to meet the complex health care needs of the population. However, advanced practice nursing should not substitute for, or replace, primary care medical practice as provided by general internists, family physicians and other physicians." Read More…
Archive »In Legislation/On The Hill
Coming Soon: Part Time National Health Service Corps Part Time Service Option
March 2010 – Health Resources and Services Administration
For application and eligibility information, click here.
To sign up to be notified when the Application Bulletin becomes available, click here.
President Obama Announces Recovery Act Awards to Build, Renovate, Community Health Centers in More Than 30 States
December 9, 2009 – Washington, DC
Centers for Medicare and Medicaid Services Proposes Rule that Would Increase Medicare Payments for Primary Care Physicians
July 1, 2009 – Washington, D.C.
"The Centers for Medicare & Medicaid Services (CMS) announced today proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). CMS is making several proposals to refine Medicare payments to physicians, which are expected to increase payment rates for primary care services." Read More…
To read the complete rule, click here.
Secretary Sebelius Makes Recovery Act Funding Available to Bolster Health Care in Needy Communities, Relieve Providers' Student Debt
June 5, 2009 - Washington, D.C.
"HHS Secretary Kathleen Sebelius today announced the availability of nearly $200 million from the American Recovery and Reinvestment Act to support student loan repayments for primary care medical, dental and mental health clinicians who want to work at National Health Service Corps (NHSC) sites. In exchange for the loan repayments, clinicians serve for two years with the Corps. The new funds are expected to double the number of Corps clinicians and make 3,300 awards to clinicians that serve in health centers, rural health clinics and other health care facilities that care for uninsured and underserved people. " Read More…
House Introduces Preserving Patient Access to Primary Care Act
May 12, 2009 – Washington, D.C.
On May 12, 2009, Rep. Allyson Schwartz (D-PA13) introduced the Preserving Patient Access to Primary Care Act (H.R. 2350). The purpose of the bill is to strengthen the nation's primary care infrastructure by providing scholarships, loan forgiveness, deferral of loan repayments and grants.
Click here for more information about the bill.
Click here to read the full bill.
Council on Graduate Medical Education Sends Letter to HHS Secretary and Congress Concerning Primary Care Crisis and Health Care Reform
May 5, 2009 – Washington, D.C.
"As the nation seeks to improve its health care delivery, the crisis in primary care looms as a major obstacle to achieving this goal. This challenge has been previously described by our committee and acknowledged by leaders of Congress. In that light, the members of COGME would like to share its key recommendations that relate to these critical issues in light of pending legislation on health care reform. These recommendations are based on the recognition that the re-invigoration of primary care is the basis for meaningful health care reform, and requires strategic investments to support primary care funding and training." Read More…
Senate HELP Committee Holds Hearing on Primary Health Care Access Reform: Community Health Centers and the National Health Service Corps
April 30, 2009 – Washington, D.C.
The Senate HELP Committee held a hearing on reforming access to primary health care. Witnesses included Fitzhugh Mullan, Dan Hawkins, Cynthia Baschetta and others. To read the statements of the of the witnesses, or to watch a video of the proceedings, click here.
House Introduces Bill to Establish a Primary and Public Health Scholarship Program
March 10, 009 – Washington, D.C.
Jim McDermott (D-WA) introduced legislation that would allow medical students to receive up to four years of a tuition-free medical education in exchange for the same number of years in an underserved area following graduation.
To read H.R. 1411, click here.
House Energy and Commerce Subcommittee on Health holds hearing on Access to Health Care
March 24, 2009 - Washington, D.C.
The House Energy and Commerce Subcommittee on Health held a hearing on "Making Health Care Work for American Families: Improving Access to Care". Witnesses included Dr. Fitzhugh Mullan, Dr. Brian Smedley, Dr. John Kitchell, Dr. Michael Sitorius, Dr. Lavizzo-Mourey, Dr. Jeffrey Harris, Dr. James Bean, and Dr. Diane Rowland.
To read the witness testimonies and listen to an audio recording of the hearing, click here.
Archive »News
Specialists earn double what primary care doctors get, study says...
May 17, 2010 – Ventura County Star
"$5.2 million vs. $2.5 million-the first number is what a cardiologist may build up in career wealth by the age of 65, according to a new Duke University study. The second shows what a primary care doctor may accrue over the same period. The gap between the numbers helps explain why family physician Josephine Soliz of Oxnard has to turn away patients nearly every day. "We're full," she said. "If we took more patients, we wouldn't be able to offer return care for the patients we already have." Read More...
Study Shows Extent of 'Invisible Work' By Family Doctors
April 29, 2010 – New York Times
"Family doctors make up the embattled front line of the nation's health care system. They earn about half the money of specialists who focus on treating particular ailments or parts of the body. That is a reason less than 10 percent of medical school graduates choose so-called primary care, which includes general internists and pediatricians." Read More…
Minnesota Programs Serve as Model for Recruiting Primary Care, Rural Doctors
May 10, 2010 – Twin Cities Daily Planet
"The need for primary care doctors and rural physicians is growing while the number of these health practitioners is shrinking. But Minnesota has found a way to counter that trend." Read More…
Modest But Important Progress in Primary Care Research Funding? The Canadian Experience
May/June 2010 – Annals of Family Medicine
"In common with the United States, Canadian primary care research has long been neglected and under-funded. This situation has persisted despite ample evidence of the key role primary care plays in producing good health outcomes, reducing disparities and controlling costs. Like our US counterparts, Canadian primary care researchers and organizations have been lobbying for at least 2 decades for enhanced funding and more focused attention to primary care research." Read More…
Alternative Providers Could Help Bridge Gap in Primary Care
May 10, 2010 – California Healthline
"Steven Johnson can tell you how bad it was. He has been a physician assistant in Palo Alto for more than 28 years. Since the entire PA profession is barely 40 years old, that almost makes him a pioneer in his field. Physician assistants work under a doctor's supervision and have the training to perform many physician tasks, from making diagnoses and running tests to deciding treatment. All of the work is done with a physician's input and approval, with the doctor signing off on many things, including prescriptions." Read More…
Payment Systems Fail to Recognize Long-Term Effects of Primary Care, Says Graham Center Director
May 12, 2010 – AAFP News Now
"Physician payment systems need to do a better job of recognizing and rewarding the long-term value of primary care services, especially as the newly enacted health care reform legislation begins to transform the U.S. health care system. That was one of the messages delivered by Robert Phillips, M.D., M.S.P.H., executive director of the AAFP's Robert Graham Center, who spoke on reinventing primary care during a May 4 forum here." Read More…
Delivering Better Primary Care
May 13, 2010 – New York Times
"What is clear is this: primary care is hurtling toward a crisis point. Once lauded as health care's frontline clinicians, primary care practitioners — general internists, family physicians, geriatricians, general pediatricians, nurse practitioners and physician assistants — are instead struggling with growing paperwork demands, inadequate and misaligned reimbursement and dwindling numbers of providers." Read More…
AAFP President Points Out Importance of Funding Primary Care Programs to Success of Health Care Legislation
May 19, 2010 – AAFP News Now
"During recent testimony before a House subcommittee, AAFP President Lori Heim, M.D., of Vass, N.C., urged Congress to increase federal investment in the primary care physician workforce to help ensure successful implementation of the recently enacted health care reform law. The number of physicians in the education pipeline for primary care has to increase if health care reform is going to succeed, said Heim." Read More…
Study Finds Many Unpaid Tasks in Primary-Care Doctors' Workday
April 29, 2010 – Washington Post
"In addition to seeing patients, a primary-care physician each day must address more than three dozen urgent but uncompensated tasks, according to a study that provides a rare, quantitative look into the mechanics of office practice." Read More…
Primary Care Doctors Dwindling as Medical Students Opt for Specialties
March 12, 2010 – Appleton Post Crescent
"Even with the increased spotlight on wellness during the national health care debate, medical students are pursuing more financially lucrative areas of specialization, including orthopedic and cardiac care. A specialist's salary - in some instances double the average $150,000 annual salary of a primary care doctor." Read More…
Principles of the Patient Centered Medical Home and Preventive Services Delivery
March/April 2010 – Annals of Family Medicine
"The patient-centered medical home (PCMH) is being promoted as the future of primary care practice that will help reform the US health care system into one that is more accessible, effective, efficient, safe, and economical." Read More…
Reform, Reform Everywhere and Not a Primary Care Drop to Drink
March/April 2010 – Annals of Family Medicine
"In 1993, nipping at the heels of potential health care reform, Franks, Nutting, and Clancy published a paper in JAMA declaring that, 'relatively few dollars...have been invested in primary care research.' They go on to state, 'an expanded research program examining the organization and process of primary care is essential...' My, how things have stayed the same." Read More…
Primary Care Gets Boost in Resident Match
March 29, 2010 – American Medical News
"The number of students matched to internal medicine, family medicine and pediatrics residencies rose 4% after falling slightly in 2008 and 2009. More primary care residency positions were offered in 2010, but the proportion of American allopathic grads choosing primary care also went up 1% over 2009. Physician leaders and medical school officials attributed the uptick in primary care residencies in part to the health system reform debate, which they say has focused renewed attention on the need for better primary care." Read More…
Without Insurance Comes a New Need: More Primary-Care Doctors
March 25, 2010 – New York Times
"Just over 30 percent of doctors are in primary care — and that is trending downward — with compensation and the culture of medical schools driving students into better-paying specialties." Read More…
As Primary Care Shortage Looms, Doctors Cut Work Hours
February 27, 2010 – USA Today
"Doctors have steadily cut their work hours over the past decade, a new study finds, something that experts say may only worsen the health care situation. And it raises policy questions amid a looming primary care doctor shortage and Congress considering an expansion of health insurance coverage that would mean more patients." Read More…
The Doctor Won't See You Now
February 6, 2010 – Newsweek
"The annual number of American medical students who go into primary care has dropped by more than half since 1997. It's hard to get an appointment with the doctors who remain. In some surveys, as many as half of primary-care providers have stopped taking new patients. The other half are increasingly overworked and harried." Read More…
Obama Budget Makes Key Investments in Primary Care, Says AAFP President
February 3, 2010 – AAFP News Now
"The Obama administration's fiscal year 2011 budget would provide funding increases for a number of primary care-related programs and, thus, would enable the U.S. health care system to take steps toward offering a high-quality, efficient and accessible health care system, according to AAFP President Lori Heim, M.D., of Vass, N.C." Read More…
Quinnipiac University Plans to Open Medical School with Emphasis on Primary Care and Global Health
January 28, 2010 – Business Wire
"President John L. Lahey announced today that the University would begin the complex process of opening a medical school, with an emphasis on primary care and global health. Quinnipiac plans to enroll its first medical school class by fall 2013 or 2014." Read More…
Low Reimbursement Drives Primary Care Docs Away
January 28, 2010 – The Lund Report
"Primary care physicians are abandoning their practices in Salem. It all boils down to money. Dr. Earl Van Volkinburg, 65, has become the latest casualty. On March 15, he'll close his Salem office after 32 years and join Kaiser Permanente two weeks later. It wasn't an easy decision." Read More…
American College of Physicians One of 118 Organizations in Supporting Equality of Medicaid and Medicare Rates for Primary Care Services
January 12, 1010 – ACP Online
"The American College of Physicians (ACP) today was one of 118 organizations that joined to send a letter to House and Senate leaders supporting equality of Medicaid and Medicare rates for primary care services. The co-signers include national and state organizations representing physicians, nurses, hospitals, and other health care providers; and consumer, labor, and other patient advocacy groups." Read More…
State of Emergency: The Disappearing Primary Care Doctor
December 16, 2009 – Rochester City Newspaper
"Primary-care physicians are often seen as gatekeepers, a term that has both positive and negative connotations. Their job is surveillance, protection, and health management. Fewer medical students going into primary care combined with a wave of retiring older doctors is putting a serious strain on the US health-care system. And industry analysts and doctors in the field say it's going to get much worse." Read More…
Demand Remains High for Family Practitioners
December 30, 2009 – Courier News
"Reforms under debate by Congress requiring nearly every American to carry insurance could create a crisis at the doctor's office. Many in the health care industry worry that the lack of enough frontline doctors -- primary care physicians -- will bottleneck medical care, with patients waiting weeks or even months for an appointment for basic medical care or for direction to a specialist." Read More…
Sen. Bernie Sanders: Health-care Bill Could Spark "A Revolution in Primary Health Care"
December 30, 2009 – Washington Post
U.S. Facing Crisis in Family Medicine
January 2, 2010 – Chicago Sun-Times
"When Dr. Gary Plundo was a medical student 30 years ago, he pursued primary-care medicine because he 'wanted to take care of families and their needs'' and "wanted to treat patients of all ages.' And Plundo, who grew up in a small town, returned to that town to practice because 'I wanted to give something back. I went to medical school for that reason.'" Read More…
It's Time We Face the Primary Care Shortage
January 6, 2010 – The Lund Report
"Fifty years ago over half of medical school graduates became general practitioners, general internists or general pediatricians. Today subspecialty training dominates by a ratio of almost 7:1. As Congress debates new health reform laws and the Oregon Health Authority ponders workforce shortages, here's what can be done to change the current pattern of behavior common in today's academic medical centers and put healthcare on the path to improved access and reduced costs." Read More…
Study: Health Center, Family Medicine Residency Pairing is 'Match Made in Heaven'
January 6, 2010 – AAFP News Now
"Training family medicine residents in community health centers, or CHCs, may provide a solution to the primary care workforce shortage, according to a study by two family physicians in Seattle. Such affiliations can be encouraged through changes in graduate medical education, or GME, funding and other proposals being discussed as part of health care reform, say the two FPs." Read More…
The Only Doctor in Town
December 5, 2009 – Washington Post
"Practicing family medicine in a place like Post puts Edwards in the minority, a fact that is not lost on policymakers in Washington. A physician shortage has long plagued rural areas. Young doctors saddled with medical school debt are more often drawn to such lucrative specialties as radiology or anesthesiology in big cities or suburban areas, where they can earn double the $120,000 to $140,000 salary of a rural family practitioner." Read More…
Organizations Urge Congress to Strengthen Primary Care Provisions in Health Care Reform Bills
December 14, 2009 – AAFP News Now
"The AAFP and several other primary care physician organizations have sent a letter to House and Senate leaders that praises various primary care provisions in the House and Senate health care reform bills but that also urges lawmakers to include other measures to strengthen the nation's primary care infrastructure." Read More…
Primary Care Shortage Hitting Communities Hard
December 11, 2009 – cnn.com
"Five years ago, roughly half the doctors leaving medical school entered the work force as primary-care physicians; just 20 percent of current medical students are planning to work in primary care. The shortage is evident everywhere, but is especially acute in rural areas." Read More…
LECOM Develops a 3-Year Medical School Curriculum to Encourage Primary Care Careers
November 5, 2009 – Physicians News Digest
"Those advocating more primary care physicians are urging an increase in medical college enrollment and giving preference to new post-graduate family medicine residencies. Since the college opened 16 years ago, the Lake Erie College of Osteopathic Medicine has been working to attract medical students into the primary care arena. This is the only medical curriculum of its kind in the United States." Read More…
Primary Care's Image Problem
November 12, 2009 – New York Times
"Even today, similar beliefs persist among medical students and trainees, though they have long since been condensed, reduced to an oft repeated acronym among those choosing specialties: I'm heading for the ROAD (radiology, ophthalmology, anesthesia and dermatology). That ROAD has had devastating effects on the physician work force in the United States. While 50 years ago half of all physicians were in primary care, almost three-quarters are now specialists. The future implications are even more dismal." Read More…
Primary Concern: Fewer Family Doctors
October 28, 2009 – Minneapolis-St. Paul Star Tribune
"It's one small piece of health care reform, but it's a big deal for medical schools and doctor's offices: forgiving the student loans of doctors who choose primary care. With fewer medical school students choosing the lower-paying fields of family medicine, internal medicine and pediatrics, lawmakers and others say something has to be done to attract them." Read More…
A Florida Medical School's Effort to Boost Primary Care
October 15, 2009 – Time Magazine
"There are 100,000 primary-care physicians in the U.S. today, but they account for only a third of all doctors; the other two-thirds are specialists. The ratio, say most experts, should be at least 50-50, as it is in countries like Canada. But the number of U.S. medical students opting for primary-care careers has plummeted 52% over the past decade, according to the American Academy of Family Physicians. Fewer than 10% of the 2008 graduating class of medical students opted for a career in primary care, and only 42% of residency positions for family medicine are being filled today, leaving a deficit of some 1,500 a year." Read More…
Wanted: More Family Doctors
October 29, 2009 – Albany Times Union
"Medical experts largely agree that 50 percent of doctors should practice primary care. But regions across New York already are far below that threshold and face dire primary care shortages before a single additional person receives an insurance card. According to the Center for Health Workforce Studies at the University of Albany: fewer than a third of Albany County physicians are generalists." Read More…
The Hidden Loss for Primary Care
Baltimore Sun, September 29, 2009
"Ryan Circh's heart is drawn to family medicine, but his head - fixated on his daunting student loans and the uncertainties of health care reform - is leading him toward emergency or sports medicine. That reflects a nationwide trend, according to the National Resident Matching Program, whose figures show about a third of graduating students are going into primary care, a number that's been dropping fairly steadily over the last generation." Read More…
FSU College of Medicine Among Nation's Top Producers of Family Doctors
WCTV Tallahassee, September 29, 2009
"Roughly 60% of FSU's medical school graduates wind up in primary care and 16.8% choose family medicine. According to The American Academy of Family Physicians that ranks FSU fifth in the nation for turning out family doctors, just as the university promised when it was trying to convince lawmakers to fund this school back in 2001. The latest numbers from the American Academy of Family Physicians show that by the year 2020, Florida will need another four thousand plus family doctors and Georgia another thousand plus to meet the need." Read More...
If Medical Coverage Extends to All, Where There Be Enough Primary Care Doctors?
St. Petersburg Times, September 30, 2009
"The national health care debate has policymakers and medical authorities worried about what comes next: If today's uninsured millions could get regular care, would there be enough doctors to serve them? Some experts say that by 2025, the nation could be short by as many as 44,000 adult general care physicians — which includes the traditional family doctors who handle everything from annual checkups to helping manage chronic conditions." Read More…
Number of Family Care Physicians Shrinking
Iowa City Press-Citizen, October 5, 2009
"Niedergeses, a fourth-year medical student scheduled to graduate in May 2010, is among the shrinking number of medical students and medical school graduates who are opting to go into family medicine. According to the American Academy of Family Physicians, about 8.2 percent of the 16,336 graduates of U.S. medical schools between July 2007 and June 2008 were first-year family medicine residents in 2008. This continued a drop from 8.3 percent in 2007 and 8.5 percent in 2006." Read More...
50 Million New Patients? More Primary Care Docs a Must
Associated Press - September 14, 2009
"Among the many hurdles facing President Barack Obama's plan to revamp the nation's health care system is a shortage of primary care physicians — those legions of overworked doctors who provide the front line of medical care for both the sick and those hoping to stay healthy. As Massachusetts' experience shows, extending health care to 50 million uninsured Americans will only further stress the system and could force many of those newly insured back into costly emergency rooms for routine care if they can't find a primary care doctor, health care observers said." Read More…
Pay Rates Keep Many Docs Out Of Primary Care
Denver Post - September 18, 2009
"The shortage of family doctors isn't just a rural problem. Even in Colorado's larger cities, including Denver and Grand Junction, people can struggle to find a primary-care physician — particularly one that accepts Medicare or Medicaid. Nationwide, the number of new American doctors choosing primary care has dropped to 25 percent from 34 percent in 2001, according to the Association of American Medical Colleges." Read More…
U.S Faces Shortage of Primary Care Physicians
Voices of America - September 15, 2009
"U.S. health experts say a shortage of primary care physicians will worsen in coming years, with American medical school graduates continuing to shun family medicine in favor of more-lucrative specialized practices like cardiology and oncology. But increasing the availability of general practitioners who treat everything from strep throat to diabetes is seen as a key to improving America's health-care system, preventing disease, and reducing cost." Read More…
Q&A With Paul Grundy, M.D., M.P.H.
AAFP News Now - September 16, 2009
"In the battle to recognize the importance of a primary care-based health care system to health care reform, computer giant IBM has been a vocal proponent of the patient-centered medical home, or PCMH. Led by its global director of health care transformation, Paul Grundy, M.D., M.P.H., the company has been immersed in encouraging other large employers to recognize that a PCMH model can lead to lower costs, as well as to improved access, quality and health care outcomes." Read More…
Next Health Crisis: Family Doc Shortage
Detroit News, August 31, 2009
"More than 1 million uninsured Michigan residents could benefit from national health care reform, but any surge in new patients could further strain a doctor population bracing for a shortage in crucial specialties. Michigan doctors already are struggling to meet the demands of an aging baby boomer population and to attract more medical school graduates into the fields of family medicine and general practice. The increasing complexity of medicine also has spurred a greater need for doctors, a trend that's only going to continue as medical technology advances." Read More…
Barbara Starfield, MD, Focuses on Primary Care and Health Care Reform
AAFP News Now, September 3, 2009
"Barbara Starfield, M.D., M.P.H., is a renowned researcher, scholar and author. A distinguished professor with appointments in the departments of Health Policy and Management and Pediatrics at the Johns Hopkins University Bloomberg School of Public Health and School of Medicine in Baltimore, she is known throughout the world for her work in demonstrating the value of primary care. AAFP News Now recently sat down to talk with Starfield about the current health care system, health care reform and the role family physicians can play in the health care reform debate." Read More…
AAFP: Supporting All Reform Bills So Far
National Journal's Under the Influence, September 3,2009
"The AAFP has formally endorsed both the House bill and the Senate Health, Education, Labor and Pensions Committee bill, the two pieces of legislation that have so far left committee. The group supports these pieces of legislation because of they include provisions that will expand coverage, primary care access and the primary care work force. The group reports that 70 percent of doctors in the U.S. are specialized, while internationally the breakdown is split 50-50 between primary care and specialized physicians. The group sees a need for a more even health care field, which it believes can happen through reform legislation." Read More…
Overhauling Health Care: Med School Grads Spurn Family Practice
Sacramento Bee, September 7, 2009
"The nation's critical shortage of primary care physicians could strain efforts to overhaul its health care system. Getting everyone in the country insured won't do much good if there aren't enough primary care doctors to take care of them, say leaders of consumer and medical groups." Read More…
Doctor Shortage Looms as Primary Care Loses Its Pull
August 17, 2009 – USA Today
"The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP). The AAFP is predicting a shortage of 40,000 family physicians in 2020, when the demand is expected to spike. The U.S. health care system has about 100,000 family physicians and will need 139,531 in 10 years. The current environment is attracting only half the number needed to meet the demand." Read More…
Doctor Shortage Looms as Primary Care Loses Its Pull
USA Today- August 17, 2009
"The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP). The AAFP is predicting a shortage of 40,000 family physicians in 2020, when the demand is expected to spike. The U.S. health care system has about 100,000 family physicians and will need 139,531 in 10 years. The current environment is attracting only half the number needed to meet the demand." Read More…
Why Primary Care Doctors are Fed Up
CNN.com - August 25, 2009
Health policy experts agree that any reform in our health care system must include a well-educated, caring primary care doctor who is able to manage the health of his or her patients with an eye to using resources optimally to keep costs down. That's a tall order and it seems that few policy makers realize the value of primary care physicians." Read More…
Nurse Practitioners Pick Up The Slack In Providing Primary Care
Baltimore Sun, August 9, 2009
"Such is the life of a busy nurse practitioner, a group of providers that is increasingly helping deliver primary care amid a national shortage of family doctors. Their days may only get busier if congressional health care reform delivers what it promises - insurance to an estimated 47 million Americans, who would be added to an already strained system of primary care. Nurse practitioners, with their focus on preventive care, make a logical fit to fill the gaps, say some observers." Read More…
Too Few Primary Care Physicians Could Mean Crisis for Family Medicine
Jacksonville.com, August 10, 2009
"Primary care and family care physicians, who must complete a three-year residency program after graduating from medical school, treat and diagnose 90 percent of all patient problems, according to the academy. Because of their extensive training, family physicians are qualified to treat most ailments for everyone from newborns to seniors. But the number of family physicians has been steadily decreasing during the past 10 years, and a large percentage of the doctors now specializing in family medicine are over 50. This comes at a time when demand for their services is on the rise." Read More…
Primary Care In Need Of First Aid
Seattle Times - August 14, 2009
"Experts say that in a well-functioning health-care system, about half of all doctors would be internists, family doctors or pediatricians, who together would comprise the category of primary-care physicians. But in the United States, only about 30 percent fall into that category (about 35 percent in Washington), and the rate of medical students going into it is far lower still — less than 10 percent nationwide." Read More…
Primary Care Key Component of Health Care Reform
AAFP News Now - August 25, 2009
"The emergence of primary care as a central part of the health care reform debate demonstrates just how far primary care has come during the past several years in driving and shaping health care policy, according to physician leaders and health policy analysts interviewed by AAFP News Now." Read More…
U.S. Facing "Primary Care Catastrophe"
The Wichita Eagle - July 26, 2009
"Primary-care doctors in family practice and internal medicine already have full schedules. And demand for them will outstrip supply in the years ahead even if the uninsured — estimated in recent years at 46 million to 47 million — don't get coverage. 'We are facing a primary-care crisis, actually a primary-care catastrophe,' Epperly said. 'We do not have the primary-care work force for this.'" Read More…
NBC Nightly News Features Segment on Primary Care
NBC Nightly News - July 15, 2009
Harvard Medical School Suspends Funding for Primary Care Division
Harvard Crimson - July 16, 2009
"Harvard Medical School has suspended funding for its Primary Care Division as part of a broader departmental restructuring effort, prompting students and faculty to circulate a petition calling on HMS Dean Jeffrey S. Flier to reaffirm the School's commitment to primary care education. The petition calls for the School's administration to present a detailed plan of action for expanding institutional support despite the budget cut, expand loan forgiveness initiatives that financially enable students to pursue primary care specialties, support efforts to strengthen primary care in a reformed national health care system, and solicit and implement proposals from the HMS
Nation Faces Shortage of Primary Care Doctors
Dallas Morning News - July 6, 2009
"Even if President Barack Obama is successful in revamping the health care system to cover the nation's 46 million uninsured, Texas and the rest of the nation still face a shortage of primary-care doctors to treat them. Since 1997, U.S. medical school graduates in family medicine and general internal medicine programs have fallen by nearly 50 percent, according to the American Academy of Family Physicians." Read More…
The Diane Rehm Show Features Segment on Primary Care
July 1, 2009 – NPR and WAMU Radio
On July 1, The Diane Rehm Show featured a segment on primary care. The show discussed the role of primary care doctors in the U.S. health care system and efforts to address what some believe is a crisis in primary care. Guests included Dr. Fitzhugh Mullan, Dr. Atul Grover and Dr. Walker Ray. Read More…
The Family Doctor: A Remedy for Health Care Costs?
Yahoo News - June 26, 2009
"The primary-care doctor is gaining new respect in Washington. Battles may be breaking out left and right over the various health-care bills emerging from Congress, but reformers on both sides agree that general practitioners should be given a central role in uniting the fragmented U.S. medical system." Read More…
Primary Care Doctor Shortage May Undermine Reform Efforts
The Washington Post - June 20, 2009
"As the debate on overhauling the nation's health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system." Read More…
A Personal, Coordinated Approach to Care
The New York Times, June 22, 2009
"The medical home concept has won the support of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association, among others. Patients, doctors and families work together to make health care more effective and reduce its costs." Read More…
Cape Nurse Practitioners Take on Primary Care
Cape Cod Times, June 22, 2009
Increasingly, patients on the Cape are receiving at least part of their primary care from nurse practitioners. A shrinking pool of primary-are physicians is driving the trend, said Dr. Ted Epperly of Boise, Idaho, president of the American Academy of Family Physicians. 'Primary care is in crisis. Nurse practitioners and physician assistants must be part of the solution. We see this as an expanded team approach.'" Read More…
Medical Students Opt for Specialties Instead of Low-Pay General Practice
Abeline Reporter - June 13, 2009
"If you are old enough to remember Marcus Welby, MD, you probably know he isn't on TV anymore, and he is rarely found practicing medicine in real life. Dr. Welby was the kindly white-coated family physician who seemingly could cure anything with just a quick exam and a little common sense. Millions of Americans don't have a family doctor these days. There aren't enough primary care physicians in many places. And those who do have a "regular" doctor often have trouble getting an appointment. When they do, it's often rushed." Read More…
Medical Summit Looks at Crisis in Primary Care
Baltimore Sun - May 28, 2009
"Maryland residents looking for a primary care doctor have a harder task every day, as the number of family doctors continues to shrink and those still practicing say they are squeezed for time and money by insurance companies and forced to shortchange patients. With heavy loan repayment burdens that often are doubled by interest, medical students are increasingly opting for better-paid specialties or urgent care shift work that limits their work hours." Read More…
Time, Money Taking Primary Care Docs "Out"
Scripps Howard News Service - April 19, 2009
"Despite widespread calls for each American to have a primary care doctor, neither government programs like Medicare and Medicaid nor private insurance generally pays doctors for quarterbacking patient care, or pays for visits addressing multiple medical issues. Family doctors, pediatricians and general practitioners end up being paid less, because the reimbursement system assumes what they do is less complex than specialists. With an aging population of patients, at least half with one or more chronic conditions and a growing list of recommended preventive care, good primary care takes a lot of time, both from the doctor and support staff." Read More…
Number of Primary Care Docs Out of Balance with Specialists
Sacramento Business Journal - May 1, 2009
"El Dorado County needs a lot more primary care doctors and specialists. Long-awaited new numbers of licensed California doctors in active practice show the supply of primary care physicians is barely adequate statewide and falls short in most counties. There are more than enough specialists, but they are not evenly distributed." Read More…
VT Doctor Urges More Primary Care
Barre Monpelier Times Argus - May 1, 2009
"Dr. Matthew, the longtime head of The Health Center in Plainfield, told the United States Senate Committee on Health, Education, Labor and Pensions that there are 60 million Americans who cannot find a doctor because of a shortage in the field. 'The days of physicians setting up shop in small communities and suburbs, even if we did train a sufficient number to care for the population, are going fast, if not gone," Matthew testified. "No primary care physician has set up a private practice in central Vermont in many years.'" Read More…
A Call for More Family Physicians
Boston Globe - April 28, 2009
"Obama has put science back on a pedestal after eight years of it being submerged by the Bush administration. A key test of connecting this to the people is whether the administration can resuscitate primary care into a prime career. Many newspapers have documented the dwindling of internal medicine and family-medicine doctors." Read More…
Sacred Heart Launches Internal Medicine Residency Program
NorthEscambia.com - April 19, 2009
Sacred Heart Health System is partnering with Lake Erie College of Osteopathic Medicine to start a three-year residency program to train physicians in osteopathic internal medicine. The targeted start date for the program is July 2009, when the first internal medicine residents will begin their training at Sacred Heart's Pensacola hospital. 'We are pleased to offer the only internal medicine residency program in Northwest Florida," says Peter Heckathorn, executive vice president of Sacred Heart Health System. "Increasing the number of internal medicine physicians is greatly needed to address the current statewide shortage of primary care physicians. This new program also will result in significant economic benefits for Northwest Florida.'" Read More…
Time, Money Taking Primary Care Docs "Out"
Scripps Howard News Service - April 19, 2009
"Despite widespread calls for each American to have a primary care doctor, neither government programs like Medicare and Medicaid nor private insurance generally pays doctors for quarterbacking patient care, or pays for visits addressing multiple medical issues. Family doctors, pediatricians and general practitioners end up being paid less, because the reimbursement system assumes what they do is less complex than specialists. With an aging population of patients, at least half with one or more chronic conditions and a growing list of recommended preventive care, good primary care takes a lot of time, both from the doctor and support staff." Read More…
Availability, Not Access, is Main Health Care Issue
Norwich Bulletin - April 18, 2009
"There is no denying our health care system is broken and needs to be fixed. Health care costs continue to rise while access to quality care diminishes. But health care reform is a complicated and complex issue, and many of the proposals being discussed on the state and national levels fall short of addressing the root causes of the problem. Numerous studies conducted during the last decade have all reached the same conclusion: In population centers where there is a higher proportion of specialists than generalists, health care is more expensive — and the mortality rate is higher. As a result of limited access to general practitioners, hospital emergency rooms and community health care centers become primary care providers — and they're overwhelmed, thus increasing the cost of health care delivery for all." Read More…
Bill May Reward Primary Care Doctors
MyFoxHouston.com - April 9, 2009
"Health care professionals say a doctor shortage in the state of Texas needs the attention of state legislators. Representatives from Houston-area clinics announced their support on Thursday for HB 1876 to create the Texas Health Care Access Fund. It would provide an incentive for medical students to become primary care physicians, by reimbursing them for education costs in exchange for a commitment to practice medicine in underserved communities." Read More…
Doctor Shortage Looms In Wisconsin: Demand For Primary Care Doctors May Go Up By 65 Percent By 2030
Madison News - April 6, 2009
"The Wisconsin Council on Medical Education and Workforce said the greatest need is for doctors specializing in family practice, internal medicine, and hospitalists. In other words, doctors serving as primary-care physicians. The report also predicts that demand for primary-care doctors will increase by 33 percent by the year 2020 and as much as 65 percent by the year 2030." Read More…
Primary-Care Shortages a Threat to all Patients
Arizona Starnet.com - April 5, 2009
"The Pima County Medical Society says primary-care physicians comprise just 16 percent of the county's active physician work force. And solo primary-care practices are becoming less common because of the high costs of operating them. Primary care typically includes family practice, internal medicine and pediatrics. Without enough primary doctors, patients may have trouble getting in to see doctors when they're ill and may rely more on emergency rooms and urgent care." Read More…
To Universal Care, via Massachusetts?
New York Times - April 4, 2009
"It is relatively easy to wish for social justice, pass a law and say it is so. But unless one understands the original problem, the wish will quickly fade under the pressure of reality. So it is with health care for all in Massachusetts. The state, like the rest of the country, lacks the keystone of any medical system: adequate primary care. And without good primary care, the coordination of care, preventive care and care of the chronically ill all become problematic." Read More…
Waxman Wants Universal Coverage But More Doctors Too
CQ Healthbeat - March 24, 2009
"House Energy and Commerce Committee Chairman Henry Waxman said Tuesday that a congressional overhaul of the health care system must not only provide for universal coverage but also for more primary care doctors and nurses to ensure that an insurance card actually gives the holder access to treatment. Witnesses at the hearing suggested various approaches to improving access, ranging from sharply increasing the supply of primary care physicians and nurses, to strengthening Medicaid to addressing racial, ethnic and geographic disparities in access to care. GOP lawmakers stressed the need to increase the supply of doctors by revisions to the medical malpractice system they said have left certain parts of the country without access to specialists." Read More…
Proposed Bill Would Increase Number of Health-Care Professionals in Underserved Areas
The Daily Texan - March 24, 2009
"At a press conference in the state Capitol Monday, Rep. Warren Chisum, R-Pampa, said a proposed bill would help increase the number of primary-care physicians, dentists and other health-care professionals in underserved areas of Texas. The bill would create the Texas Health Care Access Fund, which would pay for up to $160,000 of medical-school debt after four years of work in a shortage area." Read More…
New Report: Florida Could Save $700 Million a Year and Improve Health by Ensuring Access to Primary Care
MSNBC - March 17, 2009
A new report says Florida could save $700 million a year by making sure Floridians have a place to go for comprehensive primary care, even if they don't have health insurance. That objective got a boost this week as the Obama administration announced it will invest more than $10 million in federal stimulus dollars to fund eight new or expanded Florida community health centers. Read More…
Fewer Medical Students Choose Family Medicine in 2009 Match
AAFP News Now - March 19, 2009
"After a slight uptick in 2008, interest in family medicine among U.S. medical students has returned to its 10-year decline, as a shaky national economy and the prospect of high medical school debt appear to be luring graduating seniors into specialties other than primary care. That's the scenario suggested by the results of the 2009 National Resident Matching Program, known as the 'Match,' say Academy leaders." Read More...
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Beware of the Siren Song of New GME: Graduate Medical Education and Health Care Reform
June 15, 2009 – Fitzhugh Mullan, MD and Elizabeth Wiley, JD MPH, Health Affairs Blog
"Federal support for graduate medical education (GME) training positions has been capped for more than a decade and it is no secret that the country's teaching hospitals are restive. They want 'more cap.' A number of bills have been introduced in the House and Senate proposing an increase in the Medicare funded GME cap by fifteen percent, or roughly 15,000 positions. These proposals are an alluring Siren song but they will not be good for health care reform or for the country. What could be wrong with more residents?" Read More...
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