in health centers are nearly three times more likely to practice in underserved settings upon graduation than residents who never worked in CHCs. Among the 22 THCs created to date, 39 different sites nationwide are being funded in the amount of $150,000 per resident. Further, while many advocates of more primary care providers focus on the expansion of GME to train more doctors and dentists, others believe the scope of the problem is too big to ad- dress with physicians alone. They argue that Medicare and even Medicaid-GME funding should be expanded to cover the training of graduate Nurse Practitioners (NPs) employed not just in hospitals, but also in different types of health centers. To this end, Section 5316 of the Afford- able Care Act created a Family Nurse Practitioner Residency Training Pro- gram (NPRTP) in 15 to 20 FQHCs and Nurse-Managed Health Clinics (NMHCs) nationwide. To date, the program has helped establish NP residency training programs most affiliated with universi- ties in California, Connecticut, Maine, Massachusetts, Pennsylvania, Texas and Washington. With additional funding, more NPRTP locations will be estab- lished in Alaska, Ohio, Mississippi, New Jersey, New York and North Carolina. U.S. medical schools argue that they are working to solve the crisis by enroll- ing 30% more doctors by 2016. However, they have not yet seen a proportionate in- crease in the number of residents trained at teaching hospitals because the afore- mentioned residency cap froze Medicare- GME funded training slots at 1996 levels. Community health advocates go further and argue that GME funding must be expanded to cover physician training in both hospitals and health centers. Yet others argue, again, that only for doctors, but also other providers such as Nurse Practitioners in hospitals, health centers, Nurse-Managed Health Clinics and others. Clearly, pressure to address the problems outlined above is growing. Without changes to existing law, the fundamental goal of increased acces- sibility to affordable healthcare will not be realized. centers, and U.S. institutions of higher learning, including both medical and nursing schools, increase the number of heathcare providers needed? They can work to support legislative initiatives to address the workforce shortage: Reduction Act (S. 577/H.R. 1180), introduced by Senators Bill Nelson (D-FL), Harry Reid (D-NV) and Charles Schumer (D-NY) in the upper chamber and by Reps. Joe Crowley (D-NY) and Michael Grimm (R-NY) in the House of Representatives, would expand the residency cap and create 15,000 new GME slots (3,000/ year) over five years. Today Act (S. 577/H.R. 1201), in- troduced by Reps. Allyson Schwartz (D-PA) and Aaron Schock (R-Ill), would also create 15,000 new GME slots over five years but would reserve one-third of the new residency slots for teaching hospitals that seek to train over their Medicare cap. This bill would also give first preference to funding of hospitals in states with new medical colleges. cess Improvement Act (H.R. 487), introduced by Reps. Mike Thompson (D-CA) and Cathy McMorris Rodg- ers (R-WA) would establish pilot payments to go directly to commu- nity-based primary care physician residency programs; not just hospi- tals. Under the bill, supported by the American Association of Family Practitioners (AAFP), community- based facilities would collaborate with local hospitals, which would still provide residents with necessary in-patient training. Four models are identified for testing under the bill, which include: with two or more hospitals; develop a primary care program; dent corporation working with the community to further primary care; and collaboration with a hospital. by several members of Congress to reauthorize Sec. 5508, the Teach- ing Health Center Graduate Medical Education (THCGME) program, in response to support from the newly- established American Association of Teaching Health Centers (AATHC). nursing, and FQHCs/CHCs all have a stake in whether these legislative propos- als become law. If you wish to affect the outcome of these congressional delibera- tions, please contact me. |