America’s Voice for Community Health Care

The NACHC Mission

To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.

Building a Primary Care Workforce for the 21st CenturyPresentation to the Society of Teachers of Family MedicineTom CurtinSenior VP & Chief Medical Officer, Division of Clinical Affairs

NACHC

May 3, 2008

Building a Primary Care Workforce

Topics:• Snapshot of the Problem• NACHC Activities

• Academic Partnerships

• Public Policy Recommendations

• Research Agenda

• Coalition Building

• Key Messages

What are the Challenges We Are Facing?

“Workforce shortages may impede the expansion of the U.S. CHC safety net...During a time when serious shortages of physicians, nurses, and dentists are widespread, CHCs may face increasing competition for these essential personnel. The precipitous decline in the rate of physicians choosing generalist careers may [limit] the nation’s ability to staff CHCs and may lead to renewed shortages of safety-net and rural physicians generally.

Access to a Primary Care Workforce: A Multifaceted Problem

Studies have shown nationwide shortages of CHC Clinicians; These are more acute in Smaller, Rural CHCs:

Source: WWAMI Rural Health Research Center, November 2005

Access to a Primary Care Workforce: A Multifaceted Problem

• Training Obstacles– Not enough focus on or exposure to rural, underserved– Declining residency choice in primary care; disincentives

Source: The New England Journal of Medicine. “Becoming a Physician: Primary Care – The Best Job in Medicine?” August 31, 2006.

Physician Specialtiesof Community Health Centers

Trends in Residency Selection, 1998-2006

Access to a Primary Care Workforce: A Multifaceted Problem

• Payment Obstacles– Current reimbursement structure rewards costly procedures– Provides disincentive to preventive and primary care– Health Centers (esp. Rural) tend to lose money under the Medicare Cap

• Infrastructure and Capacity Obstacles– Need to build a physical infrastructure and system of care where new clinicians have an opportunity to serve– Particularly challenging in rural/frontier areas

What Can Be Done? What is NACHC doing?• Academic Partnerships• Public Policy Interventions• Research Agenda• Organizational Partnerships and Coalition-Building

Access to a Primary Care Workforce: A Multifaceted Problem

Academic Partnerships

A.T. Still University College of Osteopathic Medicine• Long-term partnership to identify, educate and mentor high-quality, community-minded physicians

• Medical School (Osteopathic) and Dental School•Year One – Mesa, AZ Campus•Year Two through Four – One of 10 Community Health Centers

• Preference Given to applicants:• interested in the primary care specialties (family practice, internal medicine, pediatrics, and obstetrics and gynecology),• with a history of community service, public health involvement • With a commitment to underserved communities and populations

Public Policy InterventionsReauthorize and Expand the National Health Service Corps

• Scholarships and loan repayments to medical graduates serving in underserved communities.

• NHSC should grow along with the size of the Health Centers program (FY09 NACHC Request - $150 million, 21% increase)

• Percentage of NHSC placements in health centers must continue to rise from its current level (Approx. 50%) and more explicit linkages with Health Centers must be pursued.

• Support for additional programs (Ready Responders, SEARCH, Ambassador) that ensure future pipeline.

Public Policy Interventions (cont’d)

Improve and Re-engineer Health Professions Training Programs: • Titles VII and VIII of the Public Health Service Act. • Need to focus on three policy goals:

- promoting primary care workforce

- promoting service in underserved communities - promoting a racially diverse workforce• Focus on building on successful and innovative programs already in the field.

Reauthorize and Expand of the J-1 Visa Waiver Program: • Responsible for nearly 10% of the physicians in Health Centers• Address recent migration of foreign medical graduates from J-1 visa waivers to H1-B visas and potential legislative remedies.• State Conrad-30 Program

Building the Case through Research

A Problem We Can’t Solve Alone

Coalition-Building For the Future of Primary Care• in 2007, NACHC leadership called for the convening of a new

partnership, bringing together Stakeholders from all ends of the Primary Care workforce spectrum

• includes providers (NACHC, NRHA, NAPH, etc.), physician groups (AAFP, AAP, ACP, AOA), students (AMSA), Academic Partners (AAMC, AACOM, AHEC)

• 7 meetings thus far• Developing Core Set of Principles for Future Action around:

– Strengthening Training

– Improving Payment

– Developing Infrastructure and Capacity

Key Messages

1. Solving the Workforce Challenges in Health Centers nationwide is a TOP Long-Term Priority of NACHC.

2. Solutions will not be limited to Public Policy – they must also include new academic paradigms, changes in payment systems, cultural changes and new partnerships.

3. Within Public Policy, there is a need to build infrastructure and capacity, improve training to focus on primary care/underserved populations/diversity, and reform payment systems to appropriately reimburse primary care.

4. Health Centers must “own” the workforce issue. We are affected by broader trends, but we are innovators and can lead the nation to effective solutions.

Tom’s Contact Info

Tom CurtinSenior Vice President and Chief Medical Officer

Division of Clinical Affairs National Association of Community Health Centers

7200 Wisconsin, Suite 210Bethesda, MD 20814

(301) 347-0400tcurtin@nachc.com