In a statement to the Senate HELP Committee, ACP made several arguments for expansion and funding of federal programs that strengthen the physician workforce
March 24, 2023 (ACP) — The nation's supply of health care workers, including primary care physicians, is dwindling, and the American College of Physicians is doubling down on efforts to address these shortages and protect patient health and well-being.
Time is of the essence, said Jared Frost, ACP manager for legislative affairs. “Now, with the closure of many physician practices and physicians nearing retirement not returning to the workforce after the COVID-19 pandemic, it's even more urgent,” he said. “Estimates — pre-COVID — from the Association of American Medical Colleges are that there would be a shortage of 17,800 to 48,000 primary care physicians by 2034.”
The U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) held a hearing called “Examining Health Care Workforce Shortages: Where Do We Go From Here?” on Feb. 16, and ACP weighed in with several actionable recommendations. It is likely the Senate HELP Committee will develop health care workforce shortage legislation in the coming weeks or months, Frost said.
The challenge and goal is to encourage the HELP Committee to focus as much on the physician workforce shortage as it does on the shortage of other nonphysician clinicians. “ACP made certain to emphasize that the importance of patient access to physician-led care cannot be overstated,” Frost said, noting that nonphysician practitioners are essential members of the care team and can provide quality patient care as part of a physician-led team.
In a statement submitted to the HELP Committee, ACP suggested removing student debt by strengthening the Public Service Loan Forgiveness Program, stating that the program should be expanded to help students attend medical school and encourage them to practice medicine in governmental and nonprofit settings. Passing the Resident Education Deferred Interest Act would also make it possible for medical residents to defer interest on their loans, Frost added.
In addition, ACP called for the continued expansion of Medicare-supported Graduate Medical Education (GME) by building on the recently added 1,200 GME slots. Specifically, passing the Resident Physician Reduction Shortage Act would provide 14,000 new GME positions over seven years, or 2,000 per year, to build on the 1,200 new GME slots, Frost explained.
ACP also believes that Congress should reintroduce and pass the Substance Use Disorder Workforce Act and the Opioid Workforce Act of 2021. “This bill would provide Medicare funding for 1,000 more GME positions over five years in hospitals that already have established, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry or pain medicine,” Frost explained.
The College strongly supported the $800 million for the National Health Service Corps (NHSC) $330 million for the Teaching Health Centers Graduate Medical Education (THCGME) program that were included in the American Rescue Plan Act. “Now is the time to build up these increases,” Frost said. Increasing funding for the NHSC and THCGME program, according to Frost, “would build upon the American Rescue Plan Act funding and sustain these programs and the clinician workforce for the long term,” he said.
ACP said in its statement that another way to bolster the health care workforce involves expanding Primary Care and Training Enhancement (PCTE). “Title VII Health Professions programs are also instrumental in training physicians in primary care, specifically in general internal medicine, general pediatrics and family medicine,” Frost said.
Congress increased funding for PCTE by $10 million in 2018, but more money is still needed, he added. “The PCTE program is the only program of its kind, and funding is critical to the future pipeline of primary care physicians in the workforce,” Frost said.
Another program that helps address the primary care physician shortage is the Conrad 30 program. Congress needs to reauthorize the Conrad 30 program, which allows each state's health department to recommend up to 30 international medical graduates (IMGs) a year for a waiver of the J-1 visa requirement that they return to their home country for two years. This program allows IMGs to serve in federally designated health professional shortage areas, either rural or urban. But “this reauthorization expires on Sept. 30, 2023, requiring Congress to act,” Frost explained. “The Conrad State 30 and Physician Access Reauthorization Act or similar reauthorization legislation must be enacted into law this fiscal year.”
The Healthcare Workforce Resilience Act would also help and support IMGs and their families by temporarily easing immigration-related restrictions so IMGs, as well as other critical health care workers, can enter the United States to train in internal medicine residency programs, assist in the fight against COVID-19, and provide a pathway to permanent residency status, according to Frost.