February 22, 2008

1. Senate HELP Committee Addresses Physician Workforce Shortage

2. HHS to Combat Health Care Disparities

1. Senate HELP Committee Addresses Physician Workforce Shortage

The Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing Wednesday, February 12, 2008, to address the shortage and maldistribution of physicians and other health care professionals in the United States. The hearing focused on increasing access to health care in rural communities and other medically underserved areas as well as measures that can be taken to avert a physician workforce crisis.

During the hearing, HELP committee members and witnesses applauded the Health Resources and Services Administration (HRSA) health professions training programs for their impact on recruiting primary care physicians to address the nation’s geographical maldistribution of health care professionals. Witnesses voiced their disappointment in President George W. Bush’s fiscal year 2009 budget proposal, which eliminates funding for HRSA’s health professions training programs entirely due to program “underperformance.” Many witnesses urged Congress to recommend funding levels that adequately support loans, loan guarantees, grants, and contracts that are components of these programs.

In his testimony, Kevin Grumbach, MD, Director of the University of California, San Francisco, Center for California Health Workforce Studies, presented research that contradicts the administration’s findings that HRSA health professions training programs are underperforming. According to Dr. Grumbach, HRSA program grants to medical schools are positively correlated to the increased production of primary care physicians who practice in underserved areas. Physicians who graduated from HRSA-funded US medical schools were 50% more likely to be practicing at community health centers and join the National Health Service Corps in 2001-2003 than physicians who did not receive HRSA program funding.

To combat the physician shortage, Edward Salsberg, Director of the Association of American Medical College’s Center for Workforce Studies, reiterated the association’s proposal to increase medical school enrollment by 30% as well as increase the aggregate number of graduate medical education (GME) positions to accommodate the additional graduates. In his testimony, Mr. Salsberg encouraged Congress to expand the National Health Service Corps to provide greater funding—in way of scholarships and loan repayments—to relieve medical school debt, thereby allowing more graduates to practice medicine in traditionally lower-paying, medically underserved areas.

Senator Bernie Sanders (I-VT) echoed Mr. Salsberg’s concerns for adequate health care in rural America, particularly in light of the decline in the number of American physicians interested in pursuing a career in primary care medicine. Although statistics show an increase in the number of primary care physicians, Senator Sanders noted that one out of every four primary care physicians is an international medical graduate. During the hearing, witnesses proposed a US health care system that provides greater incentives to medical students for entering selected fields.

Senator Sanders’ remarks came on the same day the Government Accountability Office (GAO) released a report that predicts an “ongoing decline in the nation’s financial support for primary care medicine.” Testifying at the HELP Committee hearing, GAO Health Care Director A. Bruce Steinwald acknowledged that primary care services are undervalued in comparison to more procedural, specialized care and recommended providing incentives for medical students to enter primary care careers. The GAO report also calls for reform of Medicare direct GME and indirect medical education payment systems.

For more information on the hearing, including a full list of witnesses and their written statements, please visit the Senate HELP Committee website.

2. HHS to Combat Health Care Disparities

The Department of Health and Human Services (HHS) Office of Minority Health (OMH), in conjunction with the non-profit National Business Group on Health, has announced a two-year, $300,000 initiative to “combat racial and ethnic disparities among minorities receiving employer-sponsored health care.” An extension of the OMH National Partnership for Action, the initiative focuses on creating partnerships between business, medicine, and public health groups to ensure the health care employers provide their workers is commensurate and fair regardless of race or ethnicity.

The initiative will educate employers on the existence of health care disparities and aid companies in implementing programs and mechanisms to counteract such inequities. Examples of improvements include contracting with health care plans that include ethnically diverse health care providers and providing on-site health care for employee groups that are unlikely to seek physician-treatment. According to OMH Deputy Assistant Secretary for Minority Health Garth Graham, MD, MPH, “we must find more effective and far-reaching strategies if we are to succeed in reducing the toll health disparities take on our health, well-being and productivity… the creation of new partnerships with business and other sectors that are impacted by these critical health issues is vital, and that is what we have begun today.”

As part of the initiative, OMH and the National Business Group on Health will create a disparities advisory board to oversee plans to present an updated business case for combating health care disparities, illuminate best practices for businesses to address disparities, and develop resources to aid companies in implementing the identified best practices. Members on the board include representatives from the American Medical Association, Corporate Human Resources, Prudential Financial, Verizon, and the National Committee for Quality Assurance.

National Business Group on Health President Helen Darling touted the initiative’s merit, arguing that “having coverage doesn’t solve the problem… It's no longer enough to provide the same benefits and hope everything works out.” According to a 1999 Kaiser Family Foundation survey, over 35% of African American and Hispanic respondents had experienced or knew someone who experienced unfair medical care because of race. Only 15% of Caucasian respondents reported similar treatment. According to Ms. Darling, as large employers provide health insurance for two-thirds of insured Americans, an initiative directed at empowering employers to advocate for equal care is an effective method to force change. Such efforts are beneficial to employers because improved health care will limit the amount of time employees are out of work for health reasons.

The Alliance for Academic Internal Medicine—the nation’s largest academically focused specialty organization—consists of the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Subspecialty Professors, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.

Please contact AAIM Vice President for Policy Charles P. Clayton (cclayton@im.org), AAIM Policy Associate Nicole V. Baptista (nbaptista@im.org), or AAIM Policy Assistant Allison L. Haupt (ahaupt@im.org) at (202) 861-9351 with questions or comments about this week’s Merlin.