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Senate Panel Discusses Primary Care Shortages

February 1, 2013—Members of the Senate Health, Education, Labor, and Pensions (HELP) Subcommittee on Primary Health and Aging discussed primary care shortages, federal loan repayment programs, and graduate medical education (GME) at a Jan. 29 hearing exploring “a major crisis regarding primary health care access.”

In his opening remarks, Subcommittee Chair Bernie Sanders (D-Vt.) cited a report he released in conjunction with the hearing, which states that up to “45,000 people die each year because they do not have health insurance and do not get to a doctor on time.” The report also compares the ratio of primary care physicians versus specialists in the U.S. to the ratio in other countries, and suggests that “Medicare has promoted the growth of residencies in specialty fields by providing tremendous sums — $10 billion each year — to teaching hospitals without requiring any emphasis on training primary care doctors.”

In a written statement  submitted to the committee, however, the AAMC points out that “past attempts to influence specialty selection through Medicare GME payments have failed,” with hospitals receiving “twice the DGME payment for primary care and geriatrics residents as compared to subspecialty fellowships.”

The statement further points out that in addition to a projected shortage of 45,000 primary care physicians by 2020, the nation also is facing a deficit of more than 46,000 specialists over the same time frame, “leaving patients with cancer, Alzheimer’s disease and dementia, hip fractures, and other ailments without immediate access to care.” Accordingly, lawmakers will be unable to resolve access issues without expanding Medicare support for graduate medical education.

At the hearing, committee members discussed other mechanisms to address the shortages, such as clinical reimbursement, federal loan repayment programs such as the National Health Service Corps (NHSC), and ways to improve the “prestige” associated with primary care. A number of witnesses, who included three physicians, two nurses, and an economist, also described how scope of practice laws impede access to care, particularly in underserved communities.


Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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