Architects of Healthcare Reform Face Critical Shortage of Primary Care Docs

By Christopher Moraff, The Philadelphia Tribune. Posted July 14, 2009.

"Study after study shows that students of color are more likely to practice in communities of need and practice in communities similar to those they came from than other students and if we can get more students to do that than we're going to provide access to communities that lack access today," said Charles Terrell, chief diversity officer at AAMC.

Potential Solutions Abound

On June 18, Epperly joined the heads of the American College of Physicians (ACP) and the American Osteopathic Association (AOA) on Capitol Hill to impress upon lawmakers the urgency of the primary care shortage. They say fixing the shortage will require a 30 percent increase in payments to primary care physicians under Medicare over the next five years.

Others have proposed more radical fixes. A 2006 study by the Institute of Medicine (IOM) recommended replacing the current "pay-for-service" fee structure with a "pay-for-performance" model.

"Medicare beneficiaries are not getting the highest possible quality of care because the program's payment system encourages volume rather than efficiency and quality," said Dr. Steven A. Schroeder, chair of the study.

The IOM acknowledged that there is little hard data on the efficacy of such a system, and so it proposes a gradual phase-in of pay-for-performance. For an initial period of three to five years, the committee recommends, Congress should reduce base Medicare payments across the board and use the money to fund rewards for strong performance. Though the plan is not directly intended to increase compensation for general practitioners, since robust primary care has been shown to keep people healthy, it would effectively amount to the same thing.

Meanwhile, lawmakers in both houses of Congress have taken steps to address the problem. In May, Rep. Allyson Schwartz (D-PA) introduced the Preserving Patient Access to Primary Care Act of 2009, which among other things would offer scholarship and loan repayment opportunities and increased Medicare reimbursement for primary care physicians. Schwartz, who has worked as a healthcare administrator and is married to a cardiologist, has made healthcare reform a key part of her agenda.

Also in the House, Rep. Jim McDermott (D-WA), himself a physician, is sponsoring a bill that would provide free tuition to state schools for medical students who agree to enter primary care fields for at least four years after graduation.  And companion bills in the Senate and House aim to reduce the physician shortage by increasing the number of Medicare-funded residency training positions by 15,000, offering incentives to hospitals that emphasize filling primary care slots.

Meanwhile, the healthcare reform bill released by the House on June 19 includes a five percent bonus for primary care services and as much as a 10 percent bonus for primary care services provided in a Health Professional Shortage Area. To qualify for the bonuses at least 50 percent of a physician's services must be primary care.

Harvard's Woolhandler says solutions like this are a good start, but will only provide temporary relief without fundamental changes in the U.S. healthcare model.

"It's like putting a Band Aid on the problem, though Band Aids can be useful," she says. "But it's not going to solve the problem if we continue to say healthcare is a business and everyone should just be going out and allocating resources based on where the money is. Healthcare is a public service… we need to run the system the way we run the fire department. No one says we're going to put up a fire department only where people are willing to pay the most."

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Christopher Moraff is a writer, journalist and photographer and a frequent contributor to In These Times and The American Prospect Online. He also works as a correspondent for The Philadelphia Tribune and is senior editor of the monthly online political journal Common Sense Magazine. He lives and works in Philadelphia.

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