The Affordable Care Act includes several provisions aimed at highlighting the importance of primary care. One provision aims to increase the number of primary care physicians by shifting more residency positions into primary care and general surgery. Under section 5503 of the ACA, hospitals must give up a portion of their unused residency slots to go into a pool to be redistributed to primary care and general surgery residency programs, primarily in rural and physician-shortage areas. Certain hospitals (such as rural teaching hospitals with fewer than 250 beds) are exempted. The shift is slated to take place in July.
Dr. Wendy Biggs of the American Academy of Family Physicians explains how residency programs – and the supply of primary care physicians – will be affected.
RN: Where will these residency slots likely go?
Geographically, the states with the lowest resident physician–to-population ratio will get 70% of the redistributed positions. States with a large number of residency programs, such as New York and California, are more likely to get the redistributed residency positions, since they also have the largest populations (making a lower ratio).
RN: Given lagging interest in primary care in recent years, will programs be able to fill additional positions?
RN: How much of a difference will this make in increasing the size of the primary care workforce?
RN: What other changes are needed to get more physicians into primary care?
We need to move away from systems that pay for episodic care and toward payment mechanisms that recognize the value of care coordination. We need to value the hallmarks of the Patient-Centered Medical Home: first-contact access, patient-focused care over time, comprehensive and coordinated care, family orientation, community orientation, and cultural competency.
DR. BIGGS is the assistant director of the division of medical education at the AAFP.
First and foremost, we need payment reform.
Source DR. BIGGS