Sarbanes Refloats Primary Care Physician Reentry Act

Participating doctors would be retrained and credentialed to serve as primary care physicians at VA medical centers, community health centers, and school-based health centers.

Congressman John Sarbanes (D-MD) has re-introduced the Primary Care Physician Reentry Act, which identifies and supports programs that retrain doctors to work as primary care providers in health centers serving veterans, local communities and schools.

Sarbanes says the bill would help medical schools, hospitals, and nonprofit organizations provide training and education programs to physicians who have left medical practice for a number of reasons, including to raise their families, to retire or for a career in administration or academia. Participating doctors would be retrained and credentialed to serve as primary care physicians at VA medical centers, community health centers, and school-based health centers.

"We have begun, wisely, to turn our healthcare system in the direction of prevention and primary care and delivery of care at the community level and that all make sense. But if you don't have enough caregivers, physicians in place to deliver those services then you aren't going to make progress on that overall vision," Sarbanes said in a recent phone interview.

"We want to help fill that shortage. And certainly there are traditional ways to do that, such as making sure that recruitment into medical schools and other traditional avenues that bring physicians into the workforce," he says.

"We can also think outside of the box and look for more non-traditional ways of bringing physicians into the workforce, or in this case back into the workforce. If we just streamline the process then we are going to generate more supply and meet the needs of the healthcare system we are designing."

Sarbanes first introduced the bill in September, 2014, but it never received a hearing. He says that's just the way things work in Congress.

"It's pretty much the same bill. Ninety percent of success in life is showing up. The equivalent of showing up for legislation is you keep reintroducing it. As long as it has merit, eventually you will get there," he says. "Frankly, that's part of the process around here. You have to keep running at the chamber and your colleagues over time and begin to bend their consciousness. We think we are making progress. We've kept the provisions pretty much intact."

"That is why you always keep coming back in a new Congress, introduce the bill, assemble your supporters, and continue to make the case to your colleagues and the people who decide what pieces of legislation get put on the floor and what don't."

The bill hasn't been officially scored for cost, but Sarbanes says a back-of-the-envelope calculation puts the cost at around $4 million.

Malpractice Liability Protections
"We don't have an official score, but we sort of estimate that is what it would be," he says. "That is real money, but it is frankly a modest investment when you consider the kinds of returns it could generate in identifying the design and modeling of what these programs can look like."

The bill contains malpractice liability protections that provide physicians with coverage under the Federal Tort Claims Act.

"We knew from the outset that having those protections would be critical and it turned out to be the case," Sarbanes says. "Critical not just for enlisting the support of the professional community that is in a position to take advantage of this re-entry program, but also critical for some of the politics here on the Hill. That is something I can point out to my Republican colleagues."

The bill has the support of key physician professional associations, including the American Academy of Family Physicians, American Academy of Pediatrics, the American Association of Colleges of Osteopathic Medicine, American College of Osteopathic Family Physicians, American Osteopathic Association, the Federation of State Medical Boards and the School-Based Health Alliance. Sarbanes says he expects the American Medical Association to voice its support once the bill is in the House pipeline.

There is no Senate co-sponsor, but Sarbanes says he's "gotten some nibbles" from the staff of several senators who've expressed an interest.

Election-Year Prospects
Next year is an election year, and Sarbanes says he's not sure if that will help or hurt his bill's prospects.

"During election years, we spend less time in Washington because people are back in their districts campaigning. So, the calendar in the election year there are fewer days in Washington. That makes it tougher," he says.

"I hope that members recognize that the public is desperate to see bipartisan collaborative efforts in D.C. because they've gotten fed up with the gridlock. Proposal like this that are common sense that we can assemble bipartisan support around are exactly the sorts of things we ought to pass to show the electorate that we working together and getting common sense measure passed. In that sense, an election year and trying to meet the expectations of the voters could help us to move this along."

Beyond that, Sarbanes says that after 50 unsuccessful attempts to repeal Obamacare, the opposition is starting to weaken.

"As that opposition wanes, there is going to be more opportunity to focus people on where we can further strengthen the ACA and fill in gaps and make refinements," Sarbanes says. "We can have those conversations in a non-threatening environment—conversations about how we can maximize some of the opportunities we were trying to create with the Affordable Care Act that will lead people to focus on some of these gaps and shortages of physicians in the system."