The 128,000-member American College of Physicians (ACP) has endorsed the Preserving Patient Access to Primary Care Act of 2009 (H.R. 2350), introduced by Rep. Allyson Schwartz (D-PA). "Primary care is the best medicine for better health and lower costs," ACP noted, "and this is the best medicine for curing the growing crisis in primary care."

Joseph W. Stubbs, MD, FACP, president of ACP, wrote Rep. Schwartz last week to congratulate her on her leadership on the critical issue. In his letter, Dr. Stubbs emphasized his own experience as a general internist practicing in a small Georgia town.

"I have been fortunate to experience the joy of working, in a collegial and collaborative fashion with nurse-practitioners, physician assistants, and other physicians on our health care team, to provide the best possible outcomes for our patients," Dr. Stubbs noted. "My own experience supports what the evidence also tells us: primary care is correlated with better health status, lower overall mortality, and longer life expectancy, and patients with primary care physicians have lower health care expenditures, as stated in the findings section of the bill."

"This bill addresses the critical shortage of primary care providers in America," said Congresswoman Schwartz. "Primary care is at the core of America's health care system, and without a sufficient number of doctors, nurses and others providing primary care, Americans face long wait times to see their doctors and health care providers, as well as other obstacles to quality care. The bill outlines a series of different measures designed to help support the field of primary care." The legislation:

* Requires a study to recommend the designation of primary care as a shortage profession, as long as certain criteria are met;
* Provides recruitment and retention incentives, through grants, scholarships, and loan forgiveness, to encourage medical students to choose careers in primary care;
* Establishes measures to support and expand the patient centered medical home (PCMH) model of care to ensure that primary care practices are able to achieve the infrastructure and have the capability to provide patient-centered, physician-guided coordinated care; and,
* Proposes comprehensive reforms of payment systems under Medicare, to support, sustain, and enhance the practice of primary care.

A recent study in the Journal of the American Medical Association showed how critical the situation is becoming. The JAMA survey results of 1,200 fourth-year medical students showed that only 2 percent plan to go into primary care internal medicine. In a similar survey in 1990, the figure was 9 percent.

"Regrettably too few young people are choosing careers in primary care medicine, and many established primary care physicians have left the field or are considering doing so in the near future," Dr. Stubbs told Rep. Schwartz. "As a result, the United States is facing a shortage of 45,000 or more primary care physicians."

"If new plans are not enacted to address the skyrocketing shortage of primary care providers, by 2025 America could face a catastrophic shortage of 46,000 primary care physicians," Rep. Schwartz emphasized. "This plan takes a wide ranging approach, including establishing scholarship and loan repayment programs; increasing Medicare reimbursements to primary care providers; eliminating copayment for preventive care services in Medicare; and several other initiatives."

The legislation will also increase the pipeline of primary care physicians and other providers by providing new scholarship and loan repayment programs for primary care service in critical shortage areas and facilities; creating a grant program to educate students about primary care careers; expanding Graduate Medical Education primary care residency positions, reducing barriers to training in office-based primary care; and authorizing higher funding levels for the Title VII health professions programs and the National Health Service Corps (NHSC).

"I was trained through the NHSC and can speak to the positive impact it has had on me and on my rural community," Dr. Stubbs said in conclusion.

"It is critical that comprehensive reforms to halt the crisis in access to primary care be included in any legislation to expand health insurance coverage," Dr. Stubbs said in agreeing with the Congresswoman. "Providing everyone with affordable coverage is essential, but coverage alone doesn't guarantee access if there aren't enough primary care physicians to take care of patients. And without primary care, the costs of covering everyone will be much higher and the outcomes much poorer."

Source: ACP