How will COGME's 20th Report Affect Medical Students?

On MedPage Today and Noteworthy (Family Practice Management Blog), official recommendations from the 20th Report by COGME (Council on Graduate Medical Education), "Advancing Primary Care,"were released to the public.  

The COGME report calls for "dramatic" policy changes that would have "immediate effect," and it proposes five recommendations:

    1. Increase the number of primary care physicians from the current level of 32 percent of U.S. physicians to at least 40 percent through new policies and programs.

    2. Raise the average incomes of primary care physicians to at least 70 percent of the median income for all other physicians, and reward practices that change their infrastructure to improve chronic care and care coordination. According to data from the Medical Group Management Association cited in the report, primary care physicians' median annual compensation was $186,044 in 2008 versus $339,738 for physicians practicing in other specialties.

    3. Require medical schools and academic health centers to develop "an accountable mission statement and measures of social responsibility to improve the health of all Americans," and to alter their selection processes and educational environments to support the goal of producing a physician workforce that is at least 40 percent primary care physicians.

    4. Change graduate medical education regulations and significantly expand Title VII funding for community-based training to support the goal of producing a physician workforce that is at least 40 percent primary care physicians. This includes requiring more residency training in outpatient settings. The report acknowledges the Affordable Care Act Primary Care Residency Expansion (PCRE) Program, a new $168 million, five-year program aimed at expanding enrollment in primary care residency programs.

    5. Increase incentives for physicians to serve medically vulnerable populations throughout the country. The report cites the Affordable Care Act's provision of $1.15 billion in funding for the National Health Service Corps to recruit more primary care physicians. COGME also recommends increasing funding for Title VII, section 747, to $560 million in Primary Care Medicine and Dentistry cluster grants and increasing funding for Community Health Centers and Area Health Education Centers.

I do not know about you, but these are pretty bold recommendations and very exciting for the future of our great specialty.  Will these recommendations gain traction anywhere within the government?  While it is true that more primary care used appropriately and effectively decreases the amount spent on healthcare, will there actually be an increase in salary?  Or would we go as far as entering into the blasphemous territories of decreasing the median specialty salary?  ::GASP:: My guess is it would probably be a little bit of both.

Enough of this crazy talk - let's just get down to workforce issues.  How will this affect medical students?  The report calls for immediate and drastic changes in order to support the 32+ million newly insured citizens upon full implementation of the Affordable Care Act (pending repeal of the reform that isn't reform of the complete government takeover of healthcare...... be scared).

If you are a medical student currently interviewing/ranking residencies and unsure about going into family medicine, are you taking this report seriously?

Here at the FOFM Blog, we are pleased to announce a 5-part series authored by Sebastian.  He will analyze each of COGME's recommendations and their potential effects on the future of family medicine and primary care workforce.  Your homework is to read the report and give a 5 minute presentation about its findings on rounds tomorrow.  You can let us know how that goes, especially if you are rotating in a specialty.  Just to cover our bases - we will not be held responsible for any adverse effects on your end-of-rotation evaluation.

Stay tuned for the series!  Family Medicine Rocks!

Meet FOFM Authors on Dr. Anonymous Show!

Thank you to all of our readers who listened to The Dr. Anonymous Show - Episode 201!

For those who could not make it live, you can listen to the show in its entirety at the link above!  Sebastian calls in after a safe trip to Houston towards the end of the show.  Enjoy!



The following description, from The Doctor Anonymous Blog, describes the episode.  We hope you enjoy learning about our pathway towards family medicine in addition to learning more about our blog and other issues in family medicine and healthcare!  Thanks Dr. A!!

"Hope you can join us this week for Doctor Anonymous Show 201 when our guests will be the authors of the blog called "Future of Family Medicine." This unique blog is written by medical students and the topics vary from health policy, to concepts like the Patient Centered Medical Home, and today's post called "The New Deal for Primary Care in Community Health Centers." Join us on Thursday, January 20, 2011 at 9pm Eastern Time on BlogTalkRadio. Also, check out the video promo above. See you for the show!"

The New Deal for Primary Care in Community Health Centers

(Image of Codman Square CHC's proposed expansion under the new federal grants. Founded in 1974, Codman Square is a FQHC located in Dorchester, MA)

2011 marks the 46th anniversary of the creation of community health centers (CHCs), which were originally created as part of the "war on poverty" in 1975. The importance of CHCs has continued to grow over the past 46 years and CHCs have continued to receive increased federal support, in large part due to bipartisan support.

One of the primary aims of community health centers is to provide good, comprehensive primary care to members of the community that it serves. CHCs disproportionately serve low-income, minority populations. 89.4% of physicians at CHCs nationally are primary care physicians and, of PCPs, 53.8% are family physicians (Rosenblatt et al, 2006). Family medicine's service model is uniquely fitted to the aims of community health centers since both aim to provide comprehensive, community-oriented care.

The large role that family medicine plays in CHCs means that the new funding and planned expansions for CHCs in the health care reform bill brings new opportunities for the specialty of family medicine! In the Patient Protection and Affordable Care Act (PPACA) passed in March 2010, $11 billion were appropriated for Community Health Center capital development grants. $9.5 billion are allocated for creation of new CHCs and expansion of existing CHCs. $1.5 billion are allocated to renovation and upkeep of existing aging CHC facilities. Currently, CHCs serve 20 million patients nationwide. By 2015, they are projected to serve twice that number, 40 million patients nationwide.

Since CHCs predominately provide for underserved populations, this increase will expand access to care to many uninsured patients and also insured patients who have been unable to find a regular primary care physician.

The expansion, while bringing increased opportunities for family physicians and other primary care doctors, also brings another question. Will there be enough FM doctors and PCPs to fill the provider positions that will become available at these new and expanded CHCs? Already, in 2006, a study showed that the average CHC has 13.3% of its family physician positions unfilled. This percentage is even larger in rural areas. This number will only increase if current trends in the primary care workforce shortage continue.

What are some effective recruitment techniques that CHCs are using?

• loan repayment: the National Health Service Corps (NHSC) and some state programs provide student loan repayment to physicians who are willing to work at CHCs. The PPACA adds $1.5 billion to NHSC funding and will add an estimated 15,000 PCPs in shortage areas.
• J-1 visa exemptions: popular among IMGs who do not have legal residency in the US as a means of staying in the USA after residency training (IMGs who come on a J-1 visa for GME training typically have to return to their home country for 2 years following residency unless they receive a J-1 visa exemption; one of the means of receiving a J-1 visa exemption is by serving at a CHC following residency)

These methods of recruitment and other movements within primary care fields provide hope for provider shortages at community health centers. However, we will need to continue to find solutions to recruit PCPs to CHCs and, more importantly, to retain those we already have, if we are to continue to provide quality care and increased access to care through the community health center model.

References:

Rosenblatt RA, Andrilla CHA, Curtin T, Hart LG. Shortages of Medical Personnel at Community Health Centers. JAMA 2006;295:1042-1049.

National Association of Community Health Centers. Community Health Centers and Health Reform: Summary of Key Health Center Provisions. http://www.nachc.com/client/Summary%20of%20Final%20Health%20Reform%20Package.pdf

Ku et al. Using Primary Care to Bend the Curve: The Effect of National Health Reform on Health Center Expansions. Geiger Gibson/RCHN Community Health Foundation. June 30 2010. Policy Research Brief No. 1.

A Medical School That Stays True To Its Mission For Primary Care

"Mercer medical school receives $1.5 million gift"

"Mercer University announced Tuesday the school has received one of its largest-ever anonymous donations that will endow a chair at the university’s School of Medicine...

"The Rufus Harris Chair will direct the medical school’s Center for Rural Heath and Health Disparities...

"According to the news release, a recent study showed the Mercer School of Medicine is one of the most successful schools in the nation at producing physicians who practice in rural areas, shortage areas and low-income areas. The study ranked Mercer second in percentage of graduates who practice in low-income areas in Georgia."

According to the Mercer University School of Medicine, their mission is:

To educate physicians and health professionals to meet the primary care and health care needs of rural and medically underserved areas of Georgia

Utilizing the Graham Center's Med School Mapper Tool, Mercer places 26% of its graduates into rural areas, 54% into HPSA shortage areas, with about 65% remaining in state and 56% into primary care. Of its graduates going into family medicine, 68% go into shortage areas and 39% into rural areas.

This is definitely an example of a medical school trying to stay true to its mission. This grant is not only going to amplify their efforts, but will really benefit the residents of Georgia.

With that being said, when looking at other medical schools, not many are willing to take on a commitment to help their communities with primary care, especially where I go to school within the urban and suburban areas in the northeast. Whose responsibility is it as we move forward to produce physicians that are needed in communities with shortages? Why is Mercer able to do this successfully, where other schools fall short?

Once 2014 hits (pending repeal/replace/laziness), will schools alter their mission statements for the sake of our nation's public health? My initial prediction - not likely but there is always hope!

Keep it up Mercer! You truly are an example of where medical schools should be focusing their efforts in producing the workforce our country truly needs.