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The number of primary-care physicians and other health professionals trained in the United States is shrinking, according to Government Accountability Office findings announced at a Senate committee hearing chaired by Senator Bernie Sanders. The nonpartisan research arm of Congress was asked to assess the state of primary-care training in the United States by Sanders and Senator Edward M. Kennedy (D-Mass.), the committee chairman. "It is beyond comprehension that America is not able to graduate the kinds of health professionals we need, and it is morally wrong that we are depleting the number of health-care providers from the poorer countries of the world," said Sanders.
The number of U.S. medical school graduates enrolled in primary-care residency programs -- such as family medicine, internal medicine and pediatrics -- fell to 22,146 in 2006 from 23,801 in 1995, according to the findings presented at a Health, Education, Labor & Pensions Committee hearing. Although the number of foreign-trained, primary-care physicians went up, Sanders called the decline in the number of Americans pursuing the specialty "troubling."
"There are simply not enough primary-care providers now and the situation will become far worse in the future unless we do something," Sanders said. He proposed doubling funds for the National Health Service Corps to $250 million next year. "Part of the solution lies in making medical, dental, and nursing education affordable for all Americans," he added.
In presenting the findings to the Senate health committee, GAO Health Care Director A. Bruce Steinwald testified that there is "a growing recognition that greater use of primary-care services and less reliance on specialty services can lead to better health outcomes at lower cost."
"The nation's over reliance on specialty-care services at the expense of primary care," Steinwald added, "leads to a health-care system that is less efficient." The GAO official also noted that the U.S. lags in life expectancy, infant mortality and health-care quality measurements despite spending more per capita than other industrialized nations.
Sanders said the solution lies in making medical, dental, and nursing education affordable for all Americans, not just for those with means. He said he looked forward to:
- Reauthorizing a health professions training act, with improved funding levels for grants, scholarships, and loan repayment that support needed professional development and community-based initiatives. This vital program funded at about $195 million dollars is targeted to be eliminated in the president's 2009 budget. This must not happen.
- Doubling the funding and size of the National Health Service Corps, as called for last year in a bill introduced by Senator Murkowski that Sen. Sanders is pleased to be an original co-sponsor of. Funding for this program is currently $125 million and incredibly has declined in the past several years. And once again, the President would cut its funding in 2009 by $3 million.
- Assuring accessible care in underserved communities by significantly increasing the appropriation level each year for community health centers. This program, funded at just under $2 billion, has been judged by the Office of Management & Budget to be one of the most efficient in using taxpayer dollars. If adequately funded over the next several years, it could increase the number of people in underserved areas who receive comprehensive primary care services from 16 million to 30 million.
- Reforming the way the $8 billion dollars that Medicare spends in support of Graduate Medical Education to reward training models that address public health needs and allow flexibility for training to occur outside of the traditional, limited numbers of sites of care.
- Correcting a disparity in Medicare and Medicaid reimbursement that favors specialty care over primary care, and rebase the Medicare FQHC reimbursement cap that was promised when the program began in 1991 and that has never occured.
To read the GAO report, click here.