Yesterday, U.S. Senator Patty Murray (D-WA), a senior member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, introduced legislation to address the looming doctor shortage in rural and underserved communities across the country. This impending crisis in access to basic, primary care is expected to result in a national shortage of approximately 52,000 primary care physicians by 2025, and a shortage of 1,695 primary care physicians in Washington state by 2030.
Murray's legislation, The Community-Based Medical Education Act of 2014, would extend the successful, but expiring, Teaching Health Center (THC) program to 2019 and train approximately 550 medical residents each year in rural and underserved communities. Beginning in 2019, the legislation would replace the THC program with a permanent, mandatory funding stream under Medicare and emphasize training of primary care physicians, particularly in community-based settings and rural and underserved areas. This program would create 1500 new residency slots nationwide.
Read a one page summary of The Community-Based Medical Education Act of 2014.
"While we've made great strides to ensure every American has access to quality, affordable health insurance, we're falling behind in training doctors who can provide basic, primary care, particularly for those in rural and underserved communities. The statistics are clear: if we don't change our system for medical training, millions of Americans will be left behind without access to basic medical care," said Senator Murray. "This legislation builds on the success we've seen in places like Yakima and Tacoma, where future physicians have been trained in community-based, rural and underserved areas, and then decided to stay and practice as a primary care physician. It helps our growing, and already strained, health care system not only to train more quality doctors, but also to provide the type of care that communities across our country desperately need."
"UW Medicine is proud to support Senator Patty Murray's legislation to ensure every community has local access to well-trained primary care physicians. As the cornerstone of the Pacific Northwest's innovative WWAMI system, UW Medicine is a national leader in educating and training physicians in a wide range of specialties, and we share Senator Murray's goal to provide every American with access to quality primary care, regardless of where they live," said Dr. Paul Ramsey, CEO, UW Medicine.
"As Dean of the WSU College of Medical Sciences I am enthusiastically supportive of Senator Murray's bill. Funding for physician residency education is critical at this time and an important complement to our goal of increasing the number of medical education seats in Washington. Supporting physician training in community settings is exactly what is needed to help meet the need for primary care physicians in underserved areas," said Ken Roberts, dean of the Washington State University College of Medical Sciences.
Several factors are contributing to the looming doctor shortage, from a cap on total medical residency slots, to an uneven distribution of physicians across medical specialties, to the undervaluation of primary care services in reimbursement systems. The problem that this bill addresses, however, is the structural issue within Medicare's graduate medical education (GME) payment system that steers future physicians away from primary care and away from rural and underserved areas. Currently, Medicare GME payments are designed primarily to reimburse teaching hospitals for the costs of physician training. These hospitals are often located in large, urban areas. As a result, residents are not sufficiently exposed to the practice of primary care and are not trained in the community-based settings where most patients most often receive that care.
This legislation builds on the success of existing models, like the THC and Rural Training Track programs, which encourage medical students to receive primary care training in community-based settings and underserved communities. These programs have shown that physicians often decide to practice in the rural and underserved communities where they're trained. In Washington state this year, the THC program provided $1.6 million to help train primary care physicians in communities like Yakima, Spokane, Toppenish, and Tacoma.
"Washington state is in crisis with a shortage of physicians, an aging physician population, a growing number of insured patients and limits on our ability to train more physicians. We need more physicians in our state to meet existing demands and to replace physicians leaving the workforce. However, you can't become a physician unless you complete a residency -- and funding for Graduate Medical Education is severely hampered. Sen. Murray's legislation is a positive step toward addressing the need for stable and sustained federal funding for Medicare GME funding," Jennifer Hanscom, CEO/Executive Director; Washington State Medical Association.
"It is important that we train primary care physicians in settings that are similar to those in which they will practice upon completion of their training. For that reason, we strongly support your effort to provide training opportunities outside of the legacy hospital-based GME system and appreciate your commitment to ensuring that such training sites have a predictable and appropriate funding source," said Dr. Jeffrey J. Cain, Board Chair of the American Academy of Family Physicians.
"The National AHEC Organization (NAO), which represents, supports and advances the AHEC Network to improve health by leading the nation in the recruitment, training and retention of a diverse health workforce for underserved communities, is pleased to support the Community-Based Medical Education Act of 2014 as proposed by Senator Patty Murray (WA). As the nation continues to face a shortage of primary care physicians, the proposed bill seeks to address the systemic issues that drive future physicians from pursuing primary care and will result in an enhanced and better distributed primary care workforce. NAO and the AHEC Network look forward to seeing the Community-Based Medical Education Act of 2014 become law," said Robert M. Trachtenberg, MS, Executive Director or the National AHEC Organization.
"We congratulate Senator Murray on her work to develop this much needed legislation that offers greater accountability of taxpayer dollars. Significant reforms to Medicare graduate medical education to increase primary care production and community-based training are included in the bill. In particular, we are especially appreciative of the inclusion of dedicated, stable funding for new types of teaching entities," said Grant Hoekzema, MD, Chair of the Council of Academic Family Medicine.
"Pacific Northwest University of Health Sciences commends Senator Murray for her notable leadership in envisioning new and innovative mechanisms of funding for critical community-based medical residency programs that will benefit not only the state of Washington, but underserved patient populations across the country," said Keith Watson, DO, President, Pacific Northwest University of Health Sciences.
"The American Geriatrics Society (AGS) appreciates Senator Murray's efforts to strengthen our nation's graduate medical education system and ensure continued access to primary care and geriatrics through her new legislation, the Community-Based Medical Education Act," said Wayne McCormick, MD, current President of AGS and a geriatrician and Professor of Medicine at the University of Washington. "The development of a new primary care teaching program that will fund 1,500 new residency spots - geriatrics included - is an important first step in building a healthcare workforce trained to care for the rapidly growing population of older Americans. We also wholeheartedly support the bill's inclusion of measures that address coordination of care across sites and working in interprofessional teams - both a hallmark of geriatrics care. AGS looks forward to working with the Senator to move this important legislation forward," said Dr. Wayne McCormick, President of the American Geriatrics Society.
"We commend Sen. Murray on her efforts to preserve and extend the Teaching Health Center program and for her efforts to expand community based residency training," said Dan Hawkins, Senior Vice President for Public Policy and Research at the National Association of Community Health Centers. "Health centers have participated in community based residency training for many years and stand ready to continue to assist with the training of the next generation of primary care providers who will ensure that our most vulnerable populations have access to care. We look forward to working with Sen. Murray as this bill moves through the legislative process."