Keep primary care close to home for all Americans

Regardless of where we live, all Americans deserve to have access to a primary care physician as such access has been demonstrated to be essential to improving care while controlling cost. And while the government has taken steps in recent years to help ensure access to care even in underserved communities, action is needed to ensure we can fulfill the demand for primary care physicians for years to come. 

At the moment, three pivotal federal programs that support local access to care for millions of Americans – the Teaching Health Center Graduate Medical Education program (THCs), community health centers, and the National Health Service Corps (NHSC) – are funded only through this September. And the uncertain fate of the Affordable Care Act (ACA), with repeal discussions continuing in Washington even after the demise of the first iteration of the American Health Care Act, complicates the future of these programs even further. 

{mosads}Initially established and later reauthorized by Congress, teaching health centers train residents in rural health clinics, urban clinics, tribal reservations, and other community settings. While roughly 50 million Americans have trouble accessing care due to their geographic location, most family physicians typically end up practicing within 50 miles of where they’re trained – driving home the need to provide training where demand is highest. Demand for the program is high; in fact, centers receive roughly 100 applications for every open residency.

Should funding for the teaching health centers disappear, the consequences could be grave. Case in point: because residency training takes three years, many teaching health centers are finding it hard to plan their staffing for the foreseeable future beyond September. Prior to the 2015 ‘funding cliff’ that culminated in the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), it was estimated that the loss of funding for THCs would disrupt the training of more than 700 medical residents in underserved communities nationwide.

The nation’s roughly 9,200 community health centers, meanwhile, provide care for patients regardless of their ability to pay in similarly underserved communities. While community health centers predate the ACA, the landmark 2010 legislation provided funding that increased the number of patients served by the centers by 5 million.

Finally, the NHSC provides loan forgiveness for physicians who commit to serving high-need areas. Currently, the program supports nearly 9,000 clinicians who provide care to nearly 10 million patients across 15,000 sites. In many ways, the NHSC makes practicing family medicine viable for talented physicians who might otherwise be discouraged by burdensome debt – all while increasing access to care.

Together, these programs help ensure that Americans can count on seeing primary care physicians within a reasonable distance of their homes. Congress had the foresight to continue funding for all three programs in MACRA, but the extension runs out in just six months. At the same time, teaching health centers are also threatened by a possible repeal of the ACA, while community health centers could lose significant funding if Congress makes substantive changes to the administration of Medicaid at the state level.

The U.S. health care system was once referred to by famed management consultant Peter Drucker as the most complex system on earth. As Congress and the administration continue to deliberate on changes to our health care system, we ask them to remember a simple principle: that all Americans deserve to be able to access a primary care physician near their homes when they need it most.

John Meigs, Jr., MD, is president of the American Academy of Family Physicians and a family physician in Centreville, Ala.

The views expressed by this author are their own and are not the views of The Hill.