Hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor, and Pensions Committee - Successful Primary Care Programs: Creating the Workforce We Need

Hearing

Sen. Bernie Sanders (I-Vt.) today chaired a Senate hearing on potential solutions to severe shortages in the nation's primary care workforce.

"In the United States today, some 45,000 people unnecessarily die each year because they don't get to a doctor in time," Sanders said. "Major reforms in primary care will save lives and save billions in health care costs," he added in his opening statement at the hearing of the Senate Subcommittee on Primary Health and Aging.

Today, one in five Americans live in an area with a shortage of primary care providers. The shortages will get worse next year when insurance coverage is expanded to 30 million more Americans under the Affordable Care Act. By 2025, more than 50,000 new primary care doctors and thousands of other providers will be necessary to meet the projected need.

The hearing explored the need to substantially increase the number of primary care practitioners by encouraging medical schools to make primary care a priority and by supporting nurse practitioner programs that place 70 percent of graduates in primary care practices.

Deborah Wachtel of Essex, Vt., president of the Vermont Nurse Practitioner Association, testified that nurse practitioners are a critical part of the primary care workforce in Vermont.

Sanders also called for expanding federal support for community health centers that provide 22 million Americans with affordable medical, dental and mental health care as well as low-cost prescription drugs. "Community health centers provide some of the most cost-effective health care in the country and serve as a medical home for millions with nowhere else to go. This excellent program has been expanded in recent years but much more needs to be done," Sanders said.

He advocated training more primary care residents through the Teaching Health Center program, which received only $230 million over the last five years compared to the $50 billion going to train residents in traditional hospital-based settings over the same period. And he called for expanding the National Health Service Corps, which provides loan-forgiveness and scholarships to students who provide medical, dental and mental health care to more than 10 million people in underserved areas.

Bernie Sander's opening statement:

In the midst of a largely dysfunctional health care system, where we spend almost twice as much per capita as any other country, one of the more glaring and obvious failures is our approach to primary care.

In the United States today, some 45,000 people unnecessarily die each year because they don't get to a doctor when they should. Many others end up suffering and in expensive hospital treatment because their medical problems were dealt with later than they should have been. Still, others flood emergency rooms at a cost ten times higher than a visit to a general practitioner because they cannot access affordable primary care when they need it. While the lack of access to primary care is a national problem, it is especially acute in medically underserved rural and inner city communities.

Instituting major reforms in primary care and enabling people to see a doctor when they need one will save lives, ease suffering and allow our nation to save billions in health care costs. What should we do?

First, we need to substantially increase the number of primary care practitioners. In most countries, about 70 percent of doctors practice primary care while 30 percent are specialists. In our country that ratio is reversed. We have about 30 percent primary care practitioners and 70 percent specialists. According to the Health Resources and Service Administration (HRSA) we need 16,000 more primary care practitioners to meet the needs that exist today, and that number will significantly increase in the years to come.

Second, we must implement a major change in the culture of our medical schools. While some medical schools do an excellent job in educating the primary care physicians that we need, many of them do very little in that area. Some do nothing at all. In 2011, about 17,000 doctors graduated from American medical schools. Only 7 percent of those graduates chose a primary care career. Needless to say, we must also change the financial remuneration and reimbursement rates which strongly incentivize medical students with high debt-loads to go into the well-paid specialties rather than primary care. We must also address the absurdity of Medicare providing $10 billion a year to teaching hospitals -- with no demands that they increase the number of primary care physicians we desperately need. As Dr. George Rust states; "Why pay to train doctors we don't need to practice in places they are not needed."

Third, we need to greatly expand the Federally Qualified Health Center (FQHC) program which, today, provides high quality and affordable health care, dental care, mental health treatment and low-cost prescription drugs to 22 million Americans. This is a program which provides some of the most costeffective health care in the country and serves as a medical home for millions with nowhere else to go. Today, there are over 1,200 Community Health Centers located in every state in the country --providing care regardless of income. This excellent program has been expanded in recent years, but much more needs to be done. The goal should be a Community Health Center in every community in America that is medically under-served.

Four, we should greatly expand the National Health Service Corps (NHSC) whichprovides loanforgiveness and scholarships to students who are prepared to provide medical, dental and mental health care in underserved areas. Like the FQHC program, the NHSC has also been expanded in recent years and, in 2012, provided financial help to nearly 10,000 clinicians, three times more than in 2008. Nonetheless, there are many more students who would like to go into primary care -- if they could escape from the very heavy burden of student loans.

The full opening statement is also available in PDF format below:
http://www.sanders.senate.gov/imo/media/doc/042313_HELPStatement.pdf

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