Primary Care Health Policy and Rural FP

Robert C. Bowman, M.D.

The nation had the best distribution of physicians with the impact of primary care health policy in the mid 1990s. Many consider this a managed care impact, but the total impact was much more including increasing primary care reimbursements from Medicare and Medicaid, decreasing reimbursements for other physicians, increasing reimbursements to those who hire and support rural and poverty primary care physicians including rural health clinics, community health and migrant centers, rural hospitals, Critical Access Hospitals, and various loan repayment efforts. Although the biggest motivator may have been the threat of not having a job if choosing non primary care positions, the overall impact was significant. The only other similar period in workforce was the time of the creation of Medicare and Medicaid with a doubling of choice of primary care, family medicine, internal medicine from 1964 to 1978. A recent IM study noted that there were 1000 fewer students matching to IM in 2004 compared to 1978. In 1978 the nation had only 12000 allopathic graduates, not the 16000 currently. When the nation's medical students can trust the nation to support them, they will choose primary care and distribute well. Several FP residency program efforts were active during the time. Some of the greatest increases in rural FP choice were in programs with accelerated graduates Accelerated Family Medicine Training Programs, who had high rates of rural choice. The influx of new "converts" to family medicine and primary care allowed primary care graduate training to diversify and fit workforce needs in inner city and rural locations. Now all programs are attempting to be all things to all students just to attract enough candidates and this training impact is gone. The smaller and more specific programs have had difficulty surviving. Health policy, admissions, education, and training all work together for physician distribution. Physician Workforce Studies