Analyzing COGME: Increase The Number of Primary Care Physicians

As mentioned by mdstudent31 mentioned, I plan on doing a 5-part series analyzing each of the recommendations behind COGME's report, Advancing Primary Care.

Before I look at the first recommendation, let's take a brief look at what COGME is and what it's authorized to do. COGME stands for the Council on Graduate Medical Education and is authorized by congress to make continuing assessments of physician workforce trends and training issues; recommend action to address identified needs; and advise the HHS Secretary and Committees responsible for health in the Senate and House.

Now onto the recommendations... the first COGME recommendation is: Policies should be implemented to raise the % of PCPs to at least 40%. This sounds like an ambitious goal given that the current level of PCPs is 32% and this number has been actively declining.

Add these 4 facts:

• In 1960, 50% of US physicians were practicing primary care
• For the past few year, 14-20% of US medical graduates have expressed interest in primary care
• Studies have shown that optimal health care outcomes and health system efficiency occurs when 40-50% of the physician workforce are PCPs
• If all those who are uninsured today receive health insurance, we will need an additional 122,000 PCPs to provide services to these patients

How can this goal be accomplished?

COGME suggests that:

• primary care needs to be made more attractive by improving compensation and providing support for restructuring practices
• changing the culture of medical student education to promote student interest in primary care
• creating policies that reward institutions for increasing GME commitment to primary care

Some short-term solutions that are proposed to better serve our patient population include:

1. Implement policies that increase non-physician clinicians (PAs, NPs, nurses and other staff positions for coordinated, integrated practice in primary care teams). This also means that we have to ensure that graduates from these programs enter program and not subspecialty care!
2. Provide incentives and regulatory reform so that all clinicians and staff work at the top of their degree. This means that primary care doctors, who have more training than PAs or NPs in terms of length and breadth of training, would move more towards coordination of care. This also helps manage health care costs.
3. Encourage and support the roles of other physicians to provide comprehensive, longitudinal primary care. It is possible for non-primary care doctors to provide some longitudinal care, although they are not fully trained for these positions. Possibly a short term response for now? Especially for some cardiologists or endocrinologists who already treat patients with chronic diseases.

Personally, I think these initial recommendations seem focused more on serving our growing patient population on the short-term but do not answer how we can best increase the % of primary care doctors so that we can better serve our nation's population. What do others think?

Next week: Recommendation 2 - changing physician payment and practice transformation for primary care (to help fulfill the first recommendation?)

How will COGME's 20th Report Affect Medical Students?

On MedPage Today and Noteworthy (Family Practice Management Blog), official recommendations from the 20th Report by COGME (Council on Graduate Medical Education), "Advancing Primary Care,"were released to the public.  

The COGME report calls for "dramatic" policy changes that would have "immediate effect," and it proposes five recommendations:

    1. Increase the number of primary care physicians from the current level of 32 percent of U.S. physicians to at least 40 percent through new policies and programs.

    2. Raise the average incomes of primary care physicians to at least 70 percent of the median income for all other physicians, and reward practices that change their infrastructure to improve chronic care and care coordination. According to data from the Medical Group Management Association cited in the report, primary care physicians' median annual compensation was $186,044 in 2008 versus $339,738 for physicians practicing in other specialties.

    3. Require medical schools and academic health centers to develop "an accountable mission statement and measures of social responsibility to improve the health of all Americans," and to alter their selection processes and educational environments to support the goal of producing a physician workforce that is at least 40 percent primary care physicians.

    4. Change graduate medical education regulations and significantly expand Title VII funding for community-based training to support the goal of producing a physician workforce that is at least 40 percent primary care physicians. This includes requiring more residency training in outpatient settings. The report acknowledges the Affordable Care Act Primary Care Residency Expansion (PCRE) Program, a new $168 million, five-year program aimed at expanding enrollment in primary care residency programs.

    5. Increase incentives for physicians to serve medically vulnerable populations throughout the country. The report cites the Affordable Care Act's provision of $1.15 billion in funding for the National Health Service Corps to recruit more primary care physicians. COGME also recommends increasing funding for Title VII, section 747, to $560 million in Primary Care Medicine and Dentistry cluster grants and increasing funding for Community Health Centers and Area Health Education Centers.

I do not know about you, but these are pretty bold recommendations and very exciting for the future of our great specialty.  Will these recommendations gain traction anywhere within the government?  While it is true that more primary care used appropriately and effectively decreases the amount spent on healthcare, will there actually be an increase in salary?  Or would we go as far as entering into the blasphemous territories of decreasing the median specialty salary?  ::GASP:: My guess is it would probably be a little bit of both.

Enough of this crazy talk - let's just get down to workforce issues.  How will this affect medical students?  The report calls for immediate and drastic changes in order to support the 32+ million newly insured citizens upon full implementation of the Affordable Care Act (pending repeal of the reform that isn't reform of the complete government takeover of healthcare...... be scared).

If you are a medical student currently interviewing/ranking residencies and unsure about going into family medicine, are you taking this report seriously?

Here at the FOFM Blog, we are pleased to announce a 5-part series authored by Sebastian.  He will analyze each of COGME's recommendations and their potential effects on the future of family medicine and primary care workforce.  Your homework is to read the report and give a 5 minute presentation about its findings on rounds tomorrow.  You can let us know how that goes, especially if you are rotating in a specialty.  Just to cover our bases - we will not be held responsible for any adverse effects on your end-of-rotation evaluation.

Stay tuned for the series!  Family Medicine Rocks!