AAFP President Says Health Reform Bill a Good Start for Addressing Physician Shortage

One of the biggest selling points in both the House and Senate versions of the presumed-to-be enacted Patient Protection and Affordable Care Act is the expansion of health insurance to approximately 30 million people who now, for whatever reason, don't have coverage.

Most people agree that expanding health insurance coverage is a good idea. The fight is usually over how to do it. Providing care could prove problematic for these newly insured Americans, however. It's already hard enough to find a primary care physician in many parts of this country without putting another 30 million seats in the waiting room.

Lori Heim, MD, president of the American Academy of Family Physicians, says she is encouraged by several provisions in both the House and Senate reform bills that begin to address the nation's dire shortage of primary care physicians.

"It's a good bill. It shows the commitment to primary care that we have heard from the president and from both sides of the aisle," Heim says. "What I hope Congress also understands is that, like many other components of this bill, it is a good start but there is much more that needs to be done."

Heim, who is a hospitalist at Scotland Memorial Hospital in Laurinburg, NC, says the reform bill begins to address several of financial obstacles that have kept medical students and residents out of primary care.

"One of the reasons why students don't tend to go into primary care as much is because of their student loans, and the big salary discrepancy between primary care and other subspecialties," Heim says. As a result, the Senate bill attempts to decrease the impact of student loans, by increasing funding for the National Health Service Corps scholarship and loan repayments. It also reauthorizes Title 7 training money for family medicine programs. There is also a health professional state loan repayment tax relief program that will incentivize primary care physicians to locate in underserved areas.

"And, at least as of now, there is still in there the redistribution of unused residency slots to primary care. That has been a bit contentious but as of now it is surviving," Heim says. "Obviously, if you try to increase interest in primary care from the medical school students, you have to make sure you have the training slots available to train them."

Heim says the issue of bonus payments for primary care physicians in Medicare is still a work in progress. There is a bonus provision of 10% in both the House and Senate reform bills that Heim calls "a good start."

"We really want to have—and hopefully this will survive—Medicaid rates being the same as Medicare. That is very important for primary care," Heim says. "That 10% bonus needs to be at least 25%. We understand that may come about sequentially but a continued positive update for family and primary care is going to be important if we really are in fear about having students take an interest in primary care."

There are some other wrinkles that must be ironed out. Heim says the Senate version extends the bonuses for five years. "We think that needs to be permanent," she says. "They also have a limit for physicians who their primary care is 60% or more of their practice. We think 50% would be more realistic."

This is not a complicated issue. For healthcare reform to succeed there has to be a very strong base of primary care physicians serving as medical traffic cops, directing and coordinating care. It's not for lack of interest that this country has a shortage of primary care physicians. The money isn't there. That has to change, and that change has to be initiated by the federal government. It's that simple. Getting there is the problem.

"Medical students, when I talk with them, they want to go into primary care. That is what most of them thought about when they thought about being a doctor," Heim says. "Now as we are rolling out the patient-centered medical home and it's getting more accepted, students are excited about that way of providing care and getting off the treadmill and providing high quality personal care. But, they keep looking at their debt and the difference in salary, so going back to look at that is important."