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Efforts to Bolster Rural Primary Care Residencies Fall Short

John Commins, for HealthLeaders Media, January 16, 2013

Much work to be done
"All the odds are stacked against them because of the way our payment systems are stacked up. They are incentivized to convert their primary care residency programs into specialty programs. They can generate more revenue that way and support some of the procedures and things that hospitals do that will bring in more revenue and make sure the bottom line is safe. I spend a lot of time looking at community-based hospitals that don't have a lot of margin. They are struggling and we don't want to see anything happen that would put those hospitals into even more jeopardy."

"The what-needs-to-be-done list is very long," she says. "A lot of people say it just can't be about GME or residency programs and we agree. We need changes in how we pay for care to strengthen the primary care workforce and incentivize people to go into primary care. We need payment and practice reforms. Primary care providers want to provide the best care, but when they feel like a hamster on a wheel they can't."

Even conceding payment and practice reforms, Chen says medical schools GME programs will still have a huge role in realigning the physician workforce. "It has to be done at the same time. If you don't, the educational system can hold back the reforms," she says.

"I would argue we have the best system in the world in terms of providing quality physicians. But there is no match in the kinds of physicians we are producing in terms of specialty and geographic distribution."

Poor distribution of physician placements
"How," asks Chen, "do we not only get the highest quality physicians but how do we get a workforce that matches the needs of the country and will support the payment and practice reforms that are aimed at getting us more comprehensive and cost efficient care?"

While the results from the 2003 legislation clearly fall short of the aspirations, Pugno says the mandate still raised the profile of primary care physicians.

"It's not a failure from the perspective that Congress is concerned about making the most of the money that they are putting into GME," he says.

"They fully recognize the need for more primary care. They fully recognize that we have maldistribution of physician placements and if we do more rural training we would have more physicians practicing in rural areas. So the basis from which they are coming and the things they are trying to fix are things we spent a decade trying to get them to recognize. So it is progress in the right direction. They just need to get some help tightening up how they write this legislation so they get the outcomes this legislation was designed to get."


John Commins is a senior editor with HealthLeaders Media.

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2 comments on "Efforts to Bolster Rural Primary Care Residencies Fall Short"


Robert Weltzien MD PhD (1/18/2013 at 2:23 PM)
I agree. I am a medical school graduate who is looking for a Family Medicine residency spot here in West Virginia and have only had two interviews this season, in spite of USMLE scores in the mid 90s, repeated commendations on bedside manner and a PhD in biomedical sciences. In addition to hiring foreigners on visas, age discrimination is widely practiced, as I am 53 years old. My plan is to practice in one of the underserved counties in this state in return for the government paying off my federal loans. I don't think that is selfish or money grubbing (like my specialist friends) but my chances are looking slimmer and slimmer. I could still give 20 years of service to the underserved; my father is 86 years old and just started a new company. I know money from Medicare has been frozen at 1996 levels to fund new spots but what are we getting ourselves into?

Jennifer Metivier (1/17/2013 at 7:50 AM)
Not only is it important to increase the number of residency slots in rural areas, the GME system needs to focus on recruiting more physicians FROM rural areas to begin with. If programs would increase the number of slots for physicicans that are FROM rural areas and trained them in rural areas, the chances of them desiring a practice in a rural area are much greater. I believe SUNY Upstate may have a program like this.