Wednesday, November 24, 2010

The Primary Care Problem

Here is a good piece from PBS that lays out one of the greatest challenges we face in health care, and it just so happens to feature members of the UC Davis Health System and School of Medicine! With a decreasing primary care workforce and a projected 30 million individuals gaining insurance coverage after 2014 through health reform, it is imperative that we ready ourselves to meet this increasing demand.  Below is an excerpt from one of my past posts at the ITUP Spotlight on Health Reform that looks at opportunities for improvement, entitled "Insurance Does Not Guarantee Access...and We're Short on Docs":

Make no mistake about it: there is a severe doctor shortage in the United States and the problem is only getting worse, especially in primary care. The Association of American Medical Colleges estimates that we could face a shortage of as many as 150,000 PCPs in the next 15 years. The reasons for this trend vary, though the comparatively lower pay, steep medical school debt, and even the personality types of those accepted to medical school are clear contributors. As a future physician, I understand the implications (and potential consequences) of this reality, and recognize that swift action must be taken. The health reform law makes significant improvements to the status quo by setting a clear priority for docs to enter primary care. Some of the provisions include:

-Up to $1 billion annually for the National Health Service Corps (a loan forgiveness program for PCPs to provide care in shortage/underserved areas), supporting more than 16,000 new primary care physicians by 2015. Learn more here.
-$125 million annually for state loan forgiveness programs in primary care
-A 10% Medicare payment bonus to primary care physicians
-Increasing Medicaid payments to Medicare levels
-Shifting unused residency slots to high-need primary care areas
-Expanding primary care residency to non-traditional (non-hospital) sites such as community health centers

-$50 million annually to expand Teaching Health Centers, with $230 million appropriated for primary care training

Though these efforts will surely be of benefit, many recognize that the root of the problem is a shortage in medical resident positions. In 1997, Congress capped the number of resident slots at 15,000, as training is tied to Medicare payments. It will be necessary to revisit the expansion of this funding (currently $9.1 billion), which did not make it into the legislation. More-so, it will be necessary to think outside the box, with a focus on non-physician providers like Nurse Practitioners and Physicians Assistants. Though somewhat controversial in expanding their scope of practice into traditionally physician's turf, the endeavor is promising (if not essential) in order to tackle the issue.

Saturday, November 13, 2010

Debrief from the Doctor Congress

One of the hats I wear is to represent UC Davis as the Alternate Delegate for the American Medical Association (AMA) Medical Students Section. Last week was the annual Interim Meeting down in San Diego, where students and physicians from around the country convened for a week of regional strategy meetings, speeches, and policy steering in regard to the present and future issues facing the medical profession.

The Medical Student Section is the 'kids table' of the organization, where we have the opportunity to set our own policy priorities. The governing body acts much like Congress, with individuals or groups submitting resolutions to change/renew/add policy to the books, the House of Delegates hearing arguments for and against the resolutions, providing amendments, and ultimately voting on each one. Besides getting to say fun things like "Thank you Mr. Speaker...", "Point of order...", and "I move to close debate and call for an immediate vote", the event offered a fascinating look into the spectrum of issues that med students across the country see as important. Major topics included advocating for student debt relief, calling for a study on the effects of agricultural subsidies on access to nutritious food, and supporting the need for broader regulation on direct-to-consumer genetic testing. UC Davis submitted two resolutions to improve Medicaid access near state lines and to advocate for taxing sugar-sweetened beverages, both of which passed (good work team!). You can see the full list here.

The Main Event opened following the close of the Med Student Section, where we heard speeches from the President of the AMA among others. Central to the talking points was the fact that even though health reform was a fierce debate fraught with disagreement, coming together and looking forward to effective implementation are the key to ultimately improving the American health care system. Physicians are the glue of the system, and as such must take an active guiding role in this transformation. Here are some of the guiding principles specific to health reform that the AMA decided on:
  • The establishment of accountable care organizations (ACOs) under health reform must be physician-led and patient-centered
  • The flawed Medicare payment formula (called the Sustainable Growth Rate) that threatens a 20% cut to reimbursements must be fixed permanently
  • Medical malpractice (tort) reform was insufficient in the Affordable Care Act, and should be addressed legitimately on the federal level
  • The AMA will initiate a grassroots campaign for adoption of the Medicare Patient Empowerment Act, a proposal that would allow patients to contract privately with physicians while retaining access to Medicare coverage