Transcript Document

America’s Voice for Community Health Care
The NACHC Mission
To promote the provision of high quality,
comprehensive and affordable health care that is
coordinated, culturally and linguistically competent,
and community directed for all medically
underserved people.
Building a Primary Care
Workforce for the 21st
Century
Presentation to the Society of Teachers of
Family Medicine
Tom Curtin
Senior VP & Chief Medical Officer, Division of Clinical Affairs
NACHC
May 3, 2008
Building a Primary Care Workforce
Topics:
• Snapshot of the Problem
• NACHC Activities
• Academic Partnerships
• Public Policy Recommendations
• Research Agenda
• Coalition Building
• Key Messages
What are the Challenges We Are Facing?
“Workforce shortages may impede the expansion of
the U.S. CHC safety net...During a time when serious
shortages of physicians, nurses, and dentists are
widespread, CHCs may face increasing competition for
these essential personnel. The precipitous decline in the
rate of physicians choosing generalist careers may [limit]
the nation’s ability to staff CHCs and may lead to
renewed shortages of safety-net and rural physicians
generally.
Access to a Primary Care Workforce:
A Multifaceted Problem
Studies have shown nationwide shortages of CHC Clinicians;
These are more acute in Smaller, Rural CHCs:
Source: WWAMI Rural Health Research Center, November 2005
Access to a Primary Care Workforce:
A Multifaceted Problem
• Training Obstacles
– Not enough focus on or exposure to rural, underserved
– Declining residency choice in primary care; disincentives
Trends in Residency Selection,
1998-2006
Physician Specialties
of Community Health Centers
Psychiatrists
3%
Obstetrician/
Gynecologists
8%
Family
Physicians
47%
General
Internists
22%
Source: The New England Journal of Medicine. “Becoming a
Physician: Primary Care – The Best Job in Medicine?” August 31,
2006.
Other
Specialists
1%
General
Pediatricians
19%
Access to a Primary Care Workforce:
A Multifaceted Problem
• Payment Obstacles
– Current reimbursement structure rewards costly procedures
– Provides disincentive to preventive and primary care
– Health Centers (esp. Rural) tend to lose money under the
Medicare Cap
• Infrastructure and Capacity Obstacles
– Need to build a physical infrastructure and system of care
where new clinicians have an opportunity to serve
– Particularly challenging in rural/frontier areas
Access to a Primary Care Workforce:
A Multifaceted Problem
What Can Be Done? What is NACHC doing?
• Academic Partnerships
• Public Policy Interventions
• Research Agenda
• Organizational Partnerships and Coalition-Building
Academic Partnerships
A.T. Still University College of Osteopathic Medicine
• Long-term partnership to identify, educate and mentor highquality, community-minded physicians
• Medical School (Osteopathic) and Dental School
•Year One – Mesa, AZ Campus
•Year Two through Four – One of 10 Community Health Centers
• Preference Given to applicants:
• interested in the primary care specialties (family practice, internal
medicine, pediatrics, and obstetrics and gynecology),
• with a history of community service, public health involvement
• With a commitment to underserved communities and populations
Public Policy Interventions
Reauthorize and Expand the National Health Service Corps
• Scholarships and loan repayments to medical graduates serving
in underserved communities.
• NHSC should grow along with the size of the Health Centers
program (FY09 NACHC Request - $150 million, 21% increase)
• Percentage of NHSC placements in health centers must continue
to rise from its current level (Approx. 50%) and more explicit
linkages with Health Centers must be pursued.
• Support for additional programs (Ready Responders, SEARCH,
Ambassador) that ensure future pipeline.
Public Policy Interventions (cont’d)
Improve and Re-engineer Health Professions Training Programs:
• Titles VII and VIII of the Public Health Service Act.
• Need to focus on three policy goals:
- promoting primary care workforce
- promoting service in underserved communities
- promoting a racially diverse workforce
• Focus on building on successful and innovative programs
already in the field.
Reauthorize and Expand of the J-1 Visa Waiver Program:
• Responsible for nearly 10% of the physicians in Health Centers
• Address recent migration of foreign medical graduates from J-1
visa waivers to H1-B visas and potential legislative remedies.
• State Conrad-30 Program
Building the Case through Research
A Problem We Can’t Solve Alone
Coalition-Building For the Future of Primary Care
• in 2007, NACHC leadership called for the convening of a new
partnership, bringing together Stakeholders from all ends of
the Primary Care workforce spectrum
• includes providers (NACHC, NRHA, NAPH, etc.), physician
groups (AAFP, AAP, ACP, AOA), students (AMSA), Academic
Partners (AAMC, AACOM, AHEC)
• 7 meetings thus far
• Developing Core Set of Principles for Future Action around:
– Strengthening Training
– Improving Payment
– Developing Infrastructure and Capacity
Key Messages
1. Solving the Workforce Challenges in Health Centers
nationwide is a TOP Long-Term Priority of NACHC.
2. Solutions will not be limited to Public Policy – they must
also include new academic paradigms, changes in
payment systems, cultural changes and new partnerships.
3. Within Public Policy, there is a need to build infrastructure
and capacity, improve training to focus on primary
care/underserved populations/diversity, and reform
payment systems to appropriately reimburse primary care.
4. Health Centers must “own” the workforce issue. We are
affected by broader trends, but we are innovators and can
lead the nation to effective solutions.
Tom’s Contact Info
Tom Curtin
Senior Vice President and Chief Medical Officer
Division of Clinical Affairs
National Association of Community Health Centers
7200 Wisconsin, Suite 210
Bethesda, MD 20814
(301) 347-0400
[email protected]