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Congress Mulls Primary Care Doc 'Re-entry' Plan Bill

 |  By John Commins  
   September 24, 2014

A bill introduced by Rep. John P. Sarbanes (D-MD) would address the nation's primary care physician shortage by funding pilot programs for mid-career, retired, and retiring physicians to continue practicing medicine.

There's a bill floating around in Congress that addresses the nation's primary care physician shortage.

 

Rep. John P. Sarbanes, (D-MD)

It's called the Primary Care Physician Reentry Act. It's sponsored by Rep. John P. Sarbanes, (D-MD), and there's plenty to like about it.

Essentially, the bill would address the nation's primary care physician shortage by funding pilot programs at medical schools, hospitals, and non-profit providers across the country. These demonstration programs would provide training, financial assistance, and streamlined reaccreditation processes for physicians wishing to re-enter the workforce.

In exchange, physicians who complete the re-entry program agree to provide primary care either full- or part-time for at least two years at community health centers, VA medical centers or school-based health centers.

What works in this legislation is the relatively light touch of the federal government. The bill addresses the need, identifies the objective, creates loose parameters, and provides funding. Providers are given leeway to design programs that they believe will be most effective.

The American Academy of Pediatrics, the American Association of Colleges of Osteopathic Medicine, the Federation of State Medical Boards, the American Osteopathic Association and the School-Based Health Alliance have provided endorsements.

The bill has been around since at least 2012, but hasn't done much in the highly partisan Congress. Rep. Sarbanes says he doesn't expect any action until a new Congress is sworn in next year, but he says he is building bipartisan support.

"I am not going to tell you that this is going to pass in the next six months; there is very little that is going to pass in the next six months," Sarbanes says. "But if you want pieces of legislation that can appeal to Republicans and Democrats here in the House this is definitely one of them."

"We will reintroduce it first thing in the next legislative session, so we are talking January or February. There are some touchstones we can point at to get people to pay attention to this. Not just the overall physician shortage, which I think folks are aware of, but, for example, this VA medical center scandal that we just had with the wait times."

Rep. Sarbanes spoke with me about this week about the bill. The following is an edited transcript.

HLM: What is the status of the bill?

JS: We introduced it in the last few days. We wanted to put it down as a marker again. We introduced it in the last Congress. We were encouraged that we were able to begin building bipartisan support for this. There are Republican colleagues of mine who expressed an interest and we are hoping that will continue and grow.

There is a general recognition from both sides of the aisle that, wherever people may be on the Affordable Care Act, there is a shortage of physicians out there, particularly in the primary care arena, and if we can find some nontraditional pipelines for bringing people to meet that shortage, then it's worth exploring.

HLM: Has the bill been scored for cost?

JS: I don't think we've gotten it scored yet. It is a relatively limited demonstration project. The idea is to see if this can work and if it does work then we can begin to invest more resources into it going forward.

The cost of that in relative terms will be pretty modest, which is why I think we can get interest even from those, and I include myself, who want to make sure that government is being efficient and fiscally responsible.

HLM: How much leeway will these pilot programs have?

JS: We expect to have them present a pretty comprehensive proposal for how to handle people who may be coming with different levels of expertise and training. So, it could be a pretty flexible design and one that is customized to the kind of practitioner who is interested in the re-entry opportunity.

We are going to learn both on the front end in terms of the best way to design the training to take full advantage of this pool of potential primary care physicians that can re-enter as well as learning from their actual deployment into these different environments where they can provide the care. It will be a fascinating project if we can get it on line.

HLM: What are the origins of this bill?

JS: There are different groups that come and meet with us on the Hill who represent primary care providers or clinics or other healthcare institutions that are equally focused on where these shortages are.

We began to hear about some physician re-entry programs that have been designed in a number of places across the country. We thought maybe we can come at this a little more systematically, look at the potential for federal resources to get behind this because you can really leverage a tremendous amount of resources on the back end of the investment.

HLM: Why did you include federal tort protections?

JS: You're talking about family medicine, internal medicine, OB/GYN, and in that arena, the issue of malpractice insurance is very salient. To be able to include that as a component of the proposal was critical and will be critical.

It's something that helps us build support across the aisle because when it comes to the malpractice debate, that can get pretty heated. We're trying to neutralize it with a mechanism by which the liability that these physicians would face can be addressed. It exists now. We just want to broaden it a little bit to cover these particular facilities and locations where they will be practicing.

HLM: It looks like you've created the rough frame and have left the details to the pilot projects.

JS: That's fair to say. We've got a certain amount of the structure set forth in our bill; mainly, who qualifies to set up these programs; who qualifies to participate in the programs; and where will these physicians who re-enter the practice be deployed?

But, we are looking forward to the kinds of proposals that come forward in terms of the specific design. In awarding the grants, I would anticipate that we'd want to experiment with a number of different approaches to see what works best when it comes time to take it to the next level we have some good data to look at.

HLM: What are the chances for this bill?

JS: There are things happening out there that allow us to bring this proposal in a compelling way, and it will be compelling to both Democrats and Republicans as we move forward. Let me be optimistic. I think we could get something like this passed in the next session of Congress.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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