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Fed Funding Aids Primary Care Need

 |  By jcantlupe@healthleadersmedia.com  
   November 18, 2010

Ramin Ahmadi, MD, director of medical education and research at Danbury Hospital in Connecticut, is finding a way to get more primary care physicians into his community.

Follow the money. The government's money, that is.

Ahmadi has been doing it for years, no matter where's he's been. He doesn't just follow the money, he tries to get ahead of the game. He watches legislation and gets a sense of what Congress is up to, what the government may want to see among those communities seeking money. He does research, helps residents get started, writes grants, and tries to get a sense early on where the money may be flowing.

After he graduated from Yale medical school and worked in New Haven years ago, he wrote grants to help get more primary care doctors into that area. At Griffin Hospital in Derby, CT, he did the same thing. So, while he was working at Danbury Hospital, Congress was putting together the "stimulus package" from the American Recovery and Reinvestment Act funds, and Ahmadi was already thinking ahead, seeing the monetary possibilities to help the hospital and the community attract more primary care physicians.

Danbury put in its application for a grant early, and by the time the government was deciding where to put the money, Ahmadi was pretty sure Danbury, a 371-bed regional medical center and university teaching hospital, was going to get some of it. Sure enough, it did.

The hospital received a five-year, $1.2 million grant to establish an innovative primary care residency program that focuses on the "patient-centered medical home" model and encourages primary care physicians to care for the underserved. The grant from the Department of Health and Human Services essentially is designed to strengthen the primary care workforce and provide community-based intervention.

Danbury Hospital is a "designated professional health storage area in the area of primary care," Ahmadi says. It is one of only two Connecticut institutions and eight in the nation to receive funding for the program under the Health Resources and Services Administration. As Danbury Hospital attempts to make a dent in the primary care physician shortage, its effort also is testament to Ahmadi's work as a grant writer, and the value for providers to wade through the bureaucracy, to get the money, as well providing care.

Ahmadi notes that an internal assessment completed by the hospital's staff showed that there was a shortage of nearly two dozen physicians within the Danbury service area. The city of Danbury itself has a population of 75,000.

Ahmadi says Danbury received the grants for primary care physicians, and while there is a need, he acknowledges, there is plenty of need throughout the country. He says Danbury's situation may be a "local magnification" of that need.

As Ahmadi sees it, it was up to him to lay out for the federal government what that need was&mdashand is.

Under the five-year federal grant, Danbury Hospital will establish a three-year residency program for a total of 18 candidates with six primary care physicians graduating each year. Four physicians have begun training at the hospital already. If the funding is extended, more will follow.

Even before the grant was approved, "we started developing a curriculum and training program," he says. "A few months after they announced the grants, I was ready and had a program in place, and now proposing to expand it." Expanding the "primary care workforce," Ahmadi says, "is a national priority."

Of course, there's a whole backstory to this, and it's something that healthleaders are all too familiar with, but obviously must be mentioned.

In case anyone needs a reminder, the Association of Medical Colleges estimates the nation will need 124,000 physicians by 2025, with primary care physicians representing 37% of the shortage. In addition, there is the upcoming potential shock of the wave of 32 million now uninsured people entering the system under the government's healthcare reform, beginning in 2015.  

Connecticut—and Danbury, in particular—faces physician shortages with the potential retirement of primary care physicians, Ahmadi says. "My colleagues in New Haven, they say they aren't taking new patients; maybe there will be a year before you get an appointment if you are a patient. I could only imagine by 2015 and 2018."

So, he says, the idea is to try as much as possible to get more primary care docs into the system. He has been a primary care doctor and has loved the work. But he acknowledges the litany of reasons why especially younger physicians don't go into the field. For many younger physicians, "they like to be comfortable. Primary care is complicated and not very well controlled. At a hospital, there is predictability, safety, and security to a young doctor in training," he says.

He says Danbury Hospital will begin an innovative, multidisciplinary curriculum that focuses attention on primary care work, including the patient-centered medical home, which is expected to become a cornerstone for patient care in evolving healthcare reform

Ahmadi says the residency program is an innovative approach, and he hopes the residents will continue to use such approaches when they go on to practice in the community.  "We need innovative ways to accomplish what we want, I'm telling you that."

The Obama Administration has announced $168 million for training more than 500 new primary care physicians by 2015. In addition, the White House says it is supporting training for new physician assistants, working to improve primary care work in underserved areas, initiating tax benefits and better access for primary care through Medicare and Medicaid. "Primary are is the backbone of preventative healthcare," the White House says bluntly.

But more is needed, Ahmadi says. "We need stakeholders getting together and the federal government to draft a plan that radically re-engineers the process to attract students to medical schools and engage them to stay in primary care."

So he is excited about the federal grant and the physician residency work ahead at Danbury Hospital. Still, there are no guarantees that these physicians will stay in primary care. "But I have a 100% track record," he says, laughing, and referring to his last go-round of grants for primary care residents, who decided to stay in primary care.

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Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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