IOM reforms need bigger role for primary care, ACP says

ACP has reviewed the Institute of Medicine's (IOM) recent efforts to revise the governance and financing of graduate medical education (GME).

While the College agrees that the nation's investment in GME should be used to train physicians with the right numbers, mix, and distribution of specialties and practice location and skills needed to meet the nation's health care workforce needs, it is also concerned that IOM did not make recommendations that address the nation's looming physician workforce crisis.

The College supports strategic increases in the number of Medicare-funded GME positions in primary care and other specialties facing shortages, including many internal medicine subspecialties, as noted in a recent press release. But ACP is particularly concerned that the IOM stated that it “did not find credible evidence” to support claims that the nation is facing a looming physician shortage, particularly in primary care specialties. Paradoxically, the IOM suggested that “GME funds might be used to finance new incentives for choosing a primary care career,” even as it questioned whether a primary care shortage exists. Although the College agrees with the IOM that more research is needed to guide physician workforce policies and that incentives, including payment reform, are needed to encourage careers in primary care, it believes there is credible evidence of a real and growing shortage of primary care physicians for adults, warranting immediate action.

Highly credible analyses conclude that the nation will need 44,000 to 46,000 additional primary care physicians by 2025. This figure does not take into account the increasing demand for primary care services, as an estimated 25 million uninsured Americans will obtain coverage through the reforms in the Affordable Care Act. There is also solid evidence that access to primary care is associated with better outcomes and lower cost of care.

ACP will be reviewing the IOM report in greater detail, offering suggestions in the spirit of building upon the many imaginative reforms recommended in the report. The College will also continue to advocate for policies to ensure an adequate supply of physicians to meet the nation's health care needs, including strategic increases in the number of Medicare-funded GME positions in primary care and other specialties facing shortages.