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Congress Seeks Funds to Address Shortage of
Primary Care Health Workers
Kathleen Hatfield is an Of Counsel attorney in Washington,
D.C., whose practice focuses primarily on healthcare policy,
federal funding and government relations important to hospitals,
community health centers and related non-profit organizations.
Law Offices of Stewart and Stewart
2100 M Street, N.W., Suite #200
Washington, D.C. 20037
202.785.4185 Phone
202.466.1286 Fax
Kathleen Hatfield
In April, Senator Bernie Sanders of
Vermont chaired a subcommittee hearing
of the Senate Health, Labor, Education
and Pension Committee on the looming
primary care worker shortage. He stated,
"some 45,000 people unnecessarily die
each year because they don't get to a
doctor when they should." He declared
that lack of access to primary care is a
serious national concern especially acute
in underserved rural communities and
inner cities.
Equally alarming is America's
projected inability to treat scores of new
patients: the American Association of
Medical Colleges estimates the shortfall
in physicians could reach approximately
91,500 by 2020, and more than 130,000
by 2025. Why the shortage?
The Problem
First, the Affordable Care Act will soon
extend medical coverage to over 30
million more Americans. Second, the
U.S. population continues to age and
will need more care: it is projected that
10,000 Americans will turn 65 years old
each day for the next 20 years. Third,
while Medicare pays a significant share
of the cost of training new doctors, money
is tight and new doctors are expensive.
Medicare reimburses hospitals for
some of their training costs using Gradu-
ate Medical Education (GME) payments
tied to the level of Medicare services
provided by the hospital. (Community
Health Centers (CHCs) are also reim-
bursed with Medicare funding, and their
costs are similarly calculated based on
the facility's Medicare share.)
Hospitals seek to expand the number
of new GME-funded physicians they can
train but are hampered by the exist-
ing residency "cap" enacted by law as
part of the 1997 Budget Act. The cap
limits hospitals to a certain number of
residents and prevents hospitals from
increasing the amount of Medicare GME
they can dedicate to training residents.
Legislation to expand the cap has been
introduced in several past congresses
by Senator Bill Nelson (D-FL), but this
year the Congress seems to be taking the
issue more seriously: upon its introduc-
tion this year, cosponsors were Senate
Majority Leader Harry Reid (D-NV) and
Charles Schumer (D-NY). Additional
Senate supporters now include Bob
Casey (D-PA), Debbie Stabenow (D-MI),
Bob Menendez (D-NJ) and William "Mo"
Cowan (D-MA), the first three of whom
serve on the Senate Finance Committee
to which the bill has been referred.
Other congressional champions who
seek to enlarge the healthcare workforce
believe the nation should also expand
the number of Federally Qualified Health
Centers (FQHCs), which today provide
medical, dental and behavioral health,
as well as prescription drugs, to 22
million patients through 1,200 health
centers. Other members of Congress
have proposed bills to provide Medicare-
funded GME to train physicians not only
in hospitals, but also in health centers.
To this end, Sec. 5508 of the Afford-
able Care Act provided $230 million
for five years to support the expansion
of primary care physician residency
training in community-based ambulatory
"Teaching Health Centers (THCs)." The
funding built on years of evidence which
North America