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Thursday Feb 27, 2014

Primary Care Education at Forefront of Obama Budget Proposal

Washington, D.C., is always an exciting place to be, but it especially was for me this week because the AAFP Board of Directors is meeting here to advocate for our members and improved health care for all Americans. But today was an even better day than I expected. As we gathered this morning before our meeting, we were encouraged by some good news in USA Today.

For months, the AAFP has been working with the White House and the Health Resources and Services Administration (HRSA) to address the need for increased funding in graduate medical education (GME). Today, information provided by the White House Office of Management and Budget reveals that there will be some good news for primary care Tuesday when President Obama releases his 2015 budget.


Specifically, the document released by the Office of Management and Budget to USA Today (and later shared with the Academy) says the Administration plans to budget an additional $5.23 billion during the next 10 years to train 13,000 more residents in primary care "and other physicians in high-need specialties." The document does not specify what those high-need specialties are, but last year the Council on Graduate Medical Education (COGME) called for increases in GME funding in "high priority specialties," including family medicine, geriatrics, general internal medicine, general surgery, high priority pediatric subspecialties and psychiatry.

The AAFP has long advocated that our country put more resources into graduating more medical students into primary care to meet the workforce needs of our country as our population continues to grow, as it continues to age, and as more patients get health insurance because of health care reform. This proposed budget speaks directly to this need.

Additional residency positions in primary care also are needed to keep pace with the opening of new medical schools and expanding medical school class sizes. COGME recommended that Congress continue funding existing GME positions and increase funding to support 3,000 more graduates per year. The President's budget would take a step in the right direction, providing additional funds through HRSA to train an additional 1,300 residents per year in high-need areas, including rural areas. It is critical, however, that any such increase that is implemented must ensure a majority of these positions be in primary care: family medicine, general internal medicine and general pediatrics.

Reinforcing this need, the document says residencies vying for the additional slots would have to demonstrate that they "train and retain physicians in primary care and use team-based models of care that enable all providers to work at the full extent of their abilities, and adopt new models of care, such as the patient-centered medical home or accountable care organizations."

It is important that we identify and finance training sites that may be outside the traditional hospital setting. The budget document says that for the new competitively awarded residency slots, priority would be given to hospitals and other community-based health care entities.

National Health Service Corps

One proven way of getting physicians into primary care is through the National Health Service Corps (NHSC). During the past several years, we have seen important growth in this program. The number of physicians serving in the NHSC has more than doubled during the current administration, from 3,600 in 2008 to 8,900 last year. The President's proposed budget would provide $3.95 billion in mandatory funds, expanding the number of NHSC health care providers in underserved areas to 15,000 each year from 2015 through 2020.

The AAFP has strongly supported growth in the NHSC, which offers scholarships and loan repayment assistance to support qualified family physicians and other health care professionals who are willing to work in communities across the country that are designated as health professional shortage areas. The program makes it easier for students to choose primary care careers without facing insurmountable debt and helps address critical access issues by placing new physicians in areas where they are needed most.

Medicaid Payment

The AAFP has been advocating for the increase of Medicaid payment rates to Medicare levels for more than four years. The proposed budget would extend increased Medicaid parity payments for primary care services through 2015 at an estimated cost of $5.44 billion.

We thank the administration for this proposed increase, and look forward to working with Congress to extend these increased rates for five years to create a period of access stability as our members continue to transform their practices to more effective patient-centered medical homes, and as we transition away from payment models that pay for volume to models that pay for value.

It's important to remember that Tuesday's announcement will be regarding a proposed budget. These specific proposals from the White House directly address the workforce needs of our country, and would help produce the critically needed primary care physicians Americans need and deserve. We are eager to continue our discussions with this administration and Congress to work to achieve these outcomes.

Much work and debate will remain before it is finalized, but this proposed budget is an important step forward as it is a real and meaningful investment in primary care. It represents recognition of the foundational role that primary care must play in our transforming health care system. The AAFP stands ready to help ensure that all Americans get the right care from the right person in the right place at the right time.

Reid Blackwelder, M.D., is President of the AAFP.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.