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Sanders: Make more primary care doctors

Sen. Bernie Sanders, I-Vt.
Sen. Bernie Sanders, I-Vt.

Sen. Bernie Sanders says Medicare and other federal health programs should play a bigger role in increasing the supply of primary care physicians.

Sanders, the Vermont independent who chairs the Senate Health, Education, Labor and Pensions (HELP) primary health subcommittee, talked about the issue today at a hearing his subcommittee organized on the state of the primary care work force.

Some experts have argued that the United States already has a shortage of primary care doctors, and that problems with access to primary care will get worse in the next few years, if the Patient Protection and Affordable Care (PPACA) succeeds at expanding the number of people who have health insurance.

U.S. medical schools graduated about 17,000 medical doctors in 2011, but only about 7 percent chose to go into primary care. 

Medicare has been spending about $10 billion per year on indirect medical education payments to teaching hospitals, "with no demands that they increase the number of primary care physicians we desperately need," Sanders said at the hearing.

Sanders also recommended that the country work to change the culture in U.S. medical schools, to make the idea of going into primary care more attractive;  expand the National Health Service Corp., which provides scholarships and loan write-offs for students who agree to provide care in low-income areas and other areas that have trouble attracting doctors; and provide more funding for physician residency programs at community health centers, as opposed to hospital-based residency programs.

President Obama recently released a fiscal year 2014 budget proposal that calls for the country to cut total Medicare indirect medical education funding by about $11 billion over 10 years.

Deborah Wachtel, a representative for the American Association of Nurse Practitioners, testified that Congress could help ease the primary care shortage by making it easier for nurse practitioners to get paid for providing primary care.

Today, for example, nurse practitioners in independent practices have trouble participating in the new "accountable care organizations" (ACOs), which are supposed to increase the efficiency of care by having  teams of providers get paid based on providing efficient care for a whole patient, rather than having each provider bill separately for each service provided.

"The current Medicare Shared Savings Program [ACO program] limits the assignment of beneficiaries to those who receive primary care services from a physician," Wachtel testified. This makes it difficult for nurse practitioners to participate."

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