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Bill looks to boost rural residencies


By Andis Robeznieks
Posted: December 15, 2011 - 3:45 pm ET
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Legislation designed to place more primary-care doctors-in-training in rural areas calls for a five-year pilot program to test four payment models for financing rural residency programs outside of hospital settings.

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Introduced by U.S. Reps. Cathy McMorris Rogers (R-Wa.) and Mike Thompson (D-Calif.), the Primary Care Workforce Access Improvement Act (PDF) would conduct two tests each of four payment models or "medical education entities." One model has a community-based, independent corporate entity collaborating with two or more hospitals; another model would have two or more hospitals operating a graduate medical education program; the third would have operations run by a hospital subsidiary or independent corporation with community governance; and the last would feature an entity (possibly a medical school) that is independent of a hospital but that collaborates with the hospital in operating GME programs.

The bill calls for the program to be budget-neutral; it would be paid for by Medicare funds redirected from hospital-based GME programs. After the pilot is completed, the Institute of Medicine would be directed to complete a report on the effects of the pilot and recommend whether aspects of the test should be expanded to all primary-care residents.

In a speech on the House floor, McMorris Rogers noted that studies have shown how doctors who train in rural areas are more likely to practice in rural areas, so this legislation will help “ensure that some of the most rural parts of our county will have greater access to doctors.”

The American Academy of Family Physicians issued a news release expressing its support of the bill and noted that the legislation was also backed by the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the National Rural Health Association, the North American Primary Care Research Group, the Society of Teachers of Family Medicine and the WWAMI regional medical education program—a partnership between the University of Washington School of Medicine and the states of Washington, Wyoming, Alaska, Montana and Idaho.

In the release, AAFP President Dr. Glen Stream (who practices in Spokane, Wash.) noted that GME funding is funneled through hospitals and that the payment formula doesn't fully compensate for training in settings where most primary care is provided—outside of hospitals.

"This system doesn’t reflect the reality of our healthcare system," Stream said in the release. "More than 90% of care delivered by primary-care physicians is in the community and the vast majority of patients get their care in community settings. So this is where much of the training for primary-care doctors should occur."

He added that funding for training influences a physician's specialty, "and the current system doesn't foster production of primary-care physicians."


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