Before I look at the first recommendation, let's take a brief look at what COGME is and what it's authorized to do. COGME stands for the Council on Graduate Medical Education and is authorized by congress to make continuing assessments of physician workforce trends and training issues; recommend action to address identified needs; and advise the HHS Secretary and Committees responsible for health in the Senate and House.
Now onto the recommendations... the first COGME recommendation is: Policies should be implemented to raise the % of PCPs to at least 40%. This sounds like an ambitious goal given that the current level of PCPs is 32% and this number has been actively declining.
Add these 4 facts:
- In 1960, 50% of US physicians were practicing primary care
- For the past few year, 14-20% of US medical graduates have expressed interest in primary care
- Studies have shown that optimal health care outcomes and health system efficiency occurs when 40-50% of the physician workforce are PCPs
- If all those who are uninsured today receive health insurance, we will need an additional 122,000 PCPs to provide services to these patients
How can this goal be accomplished?
COGME suggests that:
- primary care needs to be made more attractive by improving compensation and providing support for restructuring practices
- changing the culture of medical student education to promote student interest in primary care
- creating policies that reward institutions for increasing GME commitment to primary care
Some short-term solutions that are proposed to better serve our patient population include:
- Implement policies that increase non-physician clinicians (PAs, NPs, nurses and other staff positions for coordinated, integrated practice in primary care teams). This also means that we have to ensure that graduates from these programs enter program and not subspecialty care!
- Provide incentives and regulatory reform so that all clinicians and staff work at the top of their degree. This means that primary care doctors, who have more training than PAs or NPs in terms of length and breadth of training, would move more towards coordination of care. This also helps manage health care costs.
- Encourage and support the roles of other physicians to provide comprehensive, longitudinal primary care. It is possible for non-primary care doctors to provide some longitudinal care, although they are not fully trained for these positions. Possibly a short term response for now? Especially for some cardiologists or endocrinologists who already treat patients with chronic diseases.
Personally, I think these initial recommendations seem focused more on serving our growing patient population on the short-term but do not answer how we can best increase the % of primary care doctors so that we can better serve our nation's population. What do others think?
Next week: Recommendation 2 - changing physician payment and practice transformation for primary care (to help fulfill the first recommendation?)