Experts are calling for an infusion of about 10,000 primary care physicians into medically underserved areas over the next several years, even as medical students' interest in primary care has waned.
The nation's community health centers, which serve rural and other medically underserved communities, are currently facing a shortage of primary care providers, according to a report from the National Association of Community Health Centers, the American Academy of Family Physicians' Robert Graham Center, and George Washington University.
To fill the current gaps and expand services to nearly 30 million people by 2015, community health centers will need at least 15,585 additional primary care providers, including nearly 10,000 physicians, as well as nurse practitioners, certified nurse midwives, and physician assistants.
The report, “Access Transformed: Building a Primary Care Workforce for the 21st Century,” focuses on expanding care through community health centers since they are already positioned to deliver services in physician shortage areas.
Policy makers will need to get more medical students interested in primary care and ensure that those newly trained physicians go to work in medically underserved areas, the report concludes.
One solution offered in the report is to expand the National Health Service Corps program, which places primary care providers in federally designated Health Professional Shortage Areas. Through this program, physicians and other providers can receive scholarships or loan repayment assistance in exchange for service in a medically underserved area.
Dr. Gary Wiltz received a National Health Service Corps scholarship more than 25 years ago and still works in the small Louisiana bayou town where he settled after training.
“It's extremely gratifying,” he said.
Dr. Wiltz, an internist and CEO of the Teche Action Clinic in Franklin, La., has experienced the shortage of primary care providers firsthand. Since he's been there, the organization has never had a full complement of providers across its four clinics. Attempts to recruit an internist and a family physician for the past 2 years have been unsuccessful.
But for physicians who practice in underserved areas, the rewards can be great. Patients hold you in high esteem and are very grateful for the care they receive, he said. “You don't just treat them,” he said. “You worship with them and shop with them.”
The National Health Service Corps is a model that works but has not received enough funding to provide scholarships to all of the qualified applicants, Dr. Wiltz said.
Retention in the program is high. In fiscal year 2006, 76% of participating clinicians stayed in their positions for at least a year after their service commitments were fulfilled. But funding for the program has declined in recent years. In FY 2004, the program's funding peaked at $169.9 million, and in FY 2008, it had fallen to $123.5 million, according to the report.
The report also calls on policy makers to find a way to “revitalize” the J-1 Visa Waiver program, which has placed fewer foreign nationals into shortage areas in recent years. Under that program, foreign nationals who have received a U.S. visa for educational purposes can opt out of going back to their home countries in exchange for practicing in a federally designated Health Professional Shortage Area.
But existing federal programs will not be enough to meet the growing demand for primary care physicians and other providers. The report also calls on Congress to revise the way graduate medical education is funded to make it financially viable for residency training programs to partner with community health centers.
Even without a formal blessing from Congress, some programs are finding ways to give residents experience in community health clinics.
For example, Riverstone Health, a community health center organization in Billings, Mont., operates the fully accredited Montana Family Medicine Residency training program. The center established the program in 1995 along with two local hospitals. The program is funded through clinic revenues, graduate medical education funds that are passed through the two hospitals, and some state assistance.
The program currently includes 18 residents and receives applications from many more students than it can accommodate, said Dr. Roxanne Fahrenwald, director. About 70% of the graduates of the program have stayed on to practice in Montana, she said.
Locating a residency program at a community health center is a natural fit, Dr. Fahrenwald said, because the traditional role of residency training programs is to care for underserved populations just like in community health centers. “I would hope a lot more people would consider it,” she said.
Physician payment is another area in need of reform, according to the report. The disparity in reimbursement between procedure-related specialties and primary care needs to be addressed to help attract more students to the field, the report said.