America

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(No Transcript)
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Americas 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.
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Building a Primary Care Workforce for the 21st
Century
Presentation to the Society of Teachers of Family
Medicine
Tom CurtinSenior VP Chief Medical Officer,
Division of Clinical Affairs NACHC May 3, 2008
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Building a Primary Care Workforce

• Topics
• Snapshot of the Problem
• NACHC Activities
• Academic Partnerships
• Public Policy Recommendations
• Research Agenda
• Coalition Building
• Key Messages

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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
nations ability to staff CHCs and may lead to
renewed shortages of safety-net and rural
physicians generally.
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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
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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

Physician Specialties of Community Health Centers
Trends in Residency Selection, 1998-2006
Source The New England Journal of Medicine.
Becoming a Physician Primary Care The Best
Job in Medicine? August 31, 2006.
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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

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Access to a Primary Care Workforce A
Multifaceted Problem

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

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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

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Public Policy Interventions

• Reauthorize 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.

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Public Policy Interventions (contd)

• 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

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Building the Case through Research
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A Problem We Cant 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

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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.

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Toms Contact Info

• Tom CurtinSenior Vice President and Chief
  Medical Officer
• Division of Clinical Affairs
• National Association of Community Health
  Centers7200 Wisconsin, Suite 210Bethesda, MD
  20814
• [phone]tcurtin_at_nachc.com