Physician shortages in primary care, which were exacerbated by the COVID-19 pandemic, would get a boost from a new bill called the Doctors of Community Act.
The DOC Act would provide increased and sustained annual funding at more than $500 million per year for fiscal years 2024-2033. It would increase the number of residency slots available each year.
The bill would permanently authorize the Teaching Health Center Graduate Medical Education program to support the training of primary care medical and dental residents. The program would focus on high-need communities, according to the House Committee on Energy & Commerce.
Currently, the program gets $126.5 million per year, but funding is set to expire in 2023.
Committee Chairman Frank Pallone, Jr. (D-NJ) and Senate Health, Education, Labor, and Pensions Committee Chair Patty Murray (D-WA) introduced the legislation on Tuesday, which is expected to be introduced in the Senate next week.
WHY THIS MATTERS
The bill gives incentives for medical school graduates to go into primary care instead of choosing a more lucrative specialty such as surgery, according to Dr. Ada Stewart, president American Academy of Family Physicians and a practicing family physician at the Cooperative Health Center in South Carolina.
The DOC funding allows medical school graduates to be trained at the graduate medical education level to become family physicians. Most of these teaching health centers are in communities, not in hospitals, Stewart said. While doing residency programs, the residents provide care to these communities and often stay there after graduation.
"It promotes the investment in primary care," Stewart said. "We need more incentives to go where they're needed the most. This gives medical students the incentive and security to have training in that area."
Primary care and other physicians took a financial hit during the pandemic because most of their reimbursement was from fee-for-service payment and patients were not coming into the office. Part of the academy's advocacy is for value-based payment, Stewart said.
Payment parity for telehealth helped, as did the January physician fee schedule giving higher reimbursement, Stewart said. Payment concerns along with coding and other documentation added to physician stress and burnout. Things are improving but it's taken time to get caught up, she said.
"This provides us another opportunity to have a larger pipeline to enter into primary care and family medicine," Stewart said.
The DOC bill keeps the program permanently funded whereas prior funding was in "bits and pieces," she said.
The THCGME program supports the training of primary care physicians through annual funding authorized and appropriated by Congress.
Primary care has been undervalued for far too long, Stewart said.
If enacted, the bill would bring a reliable stream of doctors to communities of color, rural communities, and other high-need communities, according to the DOC one-pager.
There would be funding for an additional 100 new THCGME programs in communities across the country and it would create an estimated 1,600 new resident physician slots, the largest expansion to the program in more than two decades.
THE LARGER TREND
The United States was already facing a shortage of healthcare workers prior to the COVID-19 pandemic.
By 2033, the country may have an estimated shortage of between 21,400 and 55,200 primary care physicians and tens of thousands of surgical and specialty physicians, according to the one-pager.
"The pandemic exacerbated this issue, crippling health systems across the country amidst the worst surges of the disease," according to the DOC brief. "Emerging variants, long COVID-19 conditions and an aging population threaten to push our healthcare system to its limit."
The program serves vulnerable populations by funding the training of residents in community-based settings, such as Federally Qualified Health Centers, rural health clinics, and tribal health centers. The majority of THCGME training sites are located in medically underserved areas and the majority of patients served are covered by Medicaid.
The DOC Act is supported by numerous provider organizations.
ON THE RECORD
Dr. Stewart said by statement: "This program currently plays a vital role in training the next generation of primary care physicians and addressing the physician shortage. Evidence shows that patients who have access to primary care, which includes family physicians, have better health outcomes. Despite the benefits, the U.S. faces a critical shortage in the family physician workforce, in part because of underinvestment as well as a lack of opportunities and resources in medical education."
Pallone said, "The DOC Act will help address this shortage by providing permanent, reliable funding to train the next generation of primary care providers in some of the most medically underserved communities across the country. I look forward to working with Senator Murray to get this critical legislation passed and signed into law."
Murray said. "The Teaching Health Center Graduate Medical Education program is a critical pipeline that not only trains healthcare providers but brings them to communities of color, Tribal communities, rural communities, and so many other underserved areas. For years now, we've extended funding for this program on a bipartisan basis and expanded it in the wake of this pandemic, most recently in the American Rescue Plan. Extending funding for teaching health centers permanently just makes sense."
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