The number of medical graduates in primary-care residencies rose 6% during an 11-year stretch that closed in 2006. For experts who say the nation faces a shortage of such doctors, the figure is a seemingly hopeful sign. But a closer look reveals a troubling trend.
Without foreign medical graduates, the U.S. saw no change in the number of primary-care residents in 2006 compared with 1995. An influx of international graduates masked a 7% drop-off in U.S. graduates entering primary-care training, the Government Accountability Office reported at a Feb. 12 Senate hearing. Thats compared with a 5% bump in U.S. graduates who opted to train as specialists.
Primary cares sinking popularity underscores powerful economic forces that make a career in family practice or internal medicine less attractive than specialties, Bruce Steinwald, the GAOs healthcare director, told the Senate Health, Education, Labor and Pensions committee. The drop in U.S. educated primary-care residents is often cited as a reason to be concerned about how our system undervalues primary-care services, Steinwald said.
Healthcare insiders and academics testifying during the two-hour hearing echoed Steinwalds conclusion, arguing that public and private insurers fail to adequately reimburse time-intensive, low-technology primary care, making it less attractive. Medical students often take on significant debt, which can further put primary care at a disadvantage.
All of which threatens access to care in rural and low-income communities that struggle to recruit physicians and rely heavily on primary-care doctors, attendees testified. The crumbling infrastructure of primary care hits hardest in the most underserved communities of our nation, said Kevin Grumbach, director of the University of California at San Franciscos Center for California Health Workforce Studies.
In my view, if tomorrow, magically, we had healthcare for all of our people, we would still continue to have a major healthcare crisis in terms of accessibility, said Sen. Bernie Sanders (I-Vt.) during the hearing.
The GAOs report contained more promising figures on growth among nurse practitioners. Graduates of primary-care nurse practitioner programs increased 157% between 1994 and 2005, the GAO reported. Comparable figures for physician assistants were not available, the GAO said.
Senators and witnesses sharply criticized President Bushs budget plan for proposals that would eliminate more than a dozen health profession education and training programs worth $194 million, known as Title VII, and curb Medicare payments for medical education and safety net hospitals. President Bush has repeatedly sought to cut funds for Title VII, which finances workforce diversity and rural training efforts; faculty and student loans; scholarships; and loan forgiveness. Title VII spending dropped 50% in 2006 to roughly $145.2 million, but grew 27% in 2007 and 5% in 2008.
John Maupin Jr., president of the Morehouse School of Medicine, a witness at the hearing, said in an interview that the historically black Morehouse in Atlanta, Ga., relies on the federally funded education and training initiatives to help finance the schools focus on training primary-care doctors. Community-based medical schools and the hospitals and clinics that train primary-care residents often lack the research revenue, wealthy donors or commercially insured patients that help shore up the bottom line, he said.