New Legislation Introduced into Congress to Enhance Primary Care Physician Supply

On Sep. 16, Rep. John P. Sarbanes (D-Maryland) introduced a bill into the U.S. Congress called the Primary Care Physician Reentry Act, which, according to a press release from Rep. Sarbanes’s office, “aims to help ameliorate the nation’s primary care physician shortage by providing training and financial assistance to doctors returning to medical practice in exchange for their service as a public health provider.”

As the press release further noted, “This legislation would establish a grant program for medical schools, hospitals and non-profit organizations to create or expand their physician reentry programs which give physicians a streamlined process for credentialing and continuing medical education to return to medical practice after an absence. Funding could also be used to assist with credentialing fees, loan repayments and salaries. In return for this assistance, these physicians would serve at community health centers, VA medical centers or school-based health centers to help fill the shortage of primary care doctors. Participating physicians would be able to practice on a full- or part-time basis and would be covered under the Federal Tort Claims Act, which provides physicians with medical liability protection.”

Sarbanes, prior to his entering Congress in January 2007, where he represents Maryland’s Third District, had worked for some years as an attorney, spending his professional legal career at the law firm of Venable LLP in Baltimore from 1989 to 2006, where he was chair of the firm’s healthcare practice from 2000 to 2006.

Shortly after the introduction of the bill into Congress, Rep. Sarbanes spoke with HCI Editor-in-Chief Mark Hagland regarding his intentions for the bill, and his perspectives on the current and growing primary care physician shortage within the U.S. healthcare system. Below are excerpts from that interview.

Can you explain your intentions in drafting this bill?

I got to Congress in 2007; we very soon began to pave the way for the Affordable Care Act (ACA). I was able by my second term to get a position on two committees, the Energy and Commerce Committee, the principal committee I serve on today; and I was on the Health Subcommittee of that committee, and that’s where a lot of the ACA really came together legislatively. And there were obviously many different elements in that reform. A lot of the discussion was around the insurance coverage element of the legislation. But I got very interested early on in the workforce element, the supply side of this, the notion that if we’re going to cover another 30-35 million insured people, we need to figure out how to keep up supplying the demand for caregivers and providers. And we knew about the shortages. And my background in healthcare made me interested in how providers step forward and deliver care, and what changes make sense, and in particular, if we’re going to turn our healthcare system more in the direction of prevention and primary care, what are the implications for workforce needs?

Rep. John P. Sarbanes

So I became very interested in all those issues, and became interested in what we need to do to create and improve pipelines for workforce supply. And I wanted to look at some non-traditional pipelines; thus, this idea of creating a retiree cohort—what could we do to encourage them to come back into the practice of primary care? And from time to time, I came across people who had fashioned pilot reentry programs. And I wanted to do something more systematic here. So the Primary Care Physician Reentry Act would fund 10 programs that would be qualified medical institutions—medical schools, hospitals, and non-profit organizations—to provide expedited training for these physicians. It’s kind of a form of continuing medical education, but one focused on how these practitioners can be deployed into one of three arenas—school-based health centers, community health clinics, and VA medical centers. So one of the things we want to learn by doing this as a demonstration project is to learn what works in helping individuals get back into a level of clinical proficiency that you need for them to reenter the field.

So this corps would then be trained and redeployed back into the healthcare system. And I’m very committed to the idea of improving care delivery in these VA medical centers, community health clinics, and school-based health centers. And all you have to do is to look at the recent scandal at the VA, much of which had to do with clinician shortages, to see why this was needed. And one of the critical components of our proposal is that their malpractice insurance would be covered under the Federal Tort Claims Act. That’s the coverage you can get at federally qualified health centers; it basically means the physician does not have to pay out of pocket for malpractice insurance. And we would extend that beyond the VA setting to school-based health centers and community health clinics. So we’d be making it as easy as possible for retired physicians to get back into the healthcare system.

When was the bill first introduced?

We introduced it in the last Congress; our most recent reintroduction in this session was last week. There are certain organizations that will not endorse your bill until it’s been field and introduced. Those that have already endorsed it include the American Academy of Pediatrics, the American Association of Colleges of Osteopathic Medicine, the Federation of State Medical Boards, the American Osteopathic Association and the School-Based Health Alliance. Those organizations already signed onto the bill through their endorsements will be quite helpful in building sponsorship for this legislation.

This would seem to me to be very non-partisan legislation.

Yes, I can’t see anything objectionable. It’s a limited proposal, it’s a demonstration project. We’re going to test this out, and we can always expand the resources.

What funding requirements are involved?

The bill indicates such sources as are needed, but we’re talking about a relatively modest investment; these will be small grants from the federal government; but the institutions that would qualify for this would already have their own infrastructure, and they’d be able to build this training program inside their four walls, as it were. So the grants can be relatively modest and targeted, but we could prove over time that this will have been a wise investment of funds. So I think this should garner bipartisan support. The threat to it wouldn’t seem to be opposition, but the inertia that seems to grip Washington these days.

Do you have a Republican co-sponsor in the House of Representatives?

We have not yet introduced with an initial Republican co-sponsor. In the last Congress, we did have a Republican co-sponsor from the beginning, actually, a physician—Rep. Bill Cassidy, M.D. of Louisiana. He’s actually running for the Senate, so he’ll either win or won’t, but will no longer be in the House now; but I’m pretty comfortable that we’ll have good bipartisan support.

With regard to your comments about the ACA, do you think that members of the public and the news media should be more familiar with some of the internal healthcare system reform aspects of the ACA?

As complicated as health insurance aspects are, are relatively cut and dry. I think the most exciting innovations will be around delivery system reform, in terms of structures, delivery change, and the kinds of providers you enlist to improve care delivery. And with my experience of 18 years in healthcare law practice, I think we’ll see tremendous amounts of innovation around how healthcare is delivered. There are turfs that exist, and there are segments that will change dramatically; and that will be as a result of this increased emphasis on primary and preventive care; and you can even envision, if you turn your system more towards prevention, you have the potential to engage patients as part of their provider team, and that’s quite a hopeful concept, because with the Baby Boom generation bearing down on us, if they can be enlisted to participate in their own care and prevention, they don’t seem like such a burden anymore.

So I think the innovation on the ground—and things that will encourage physicians who have left medical practice to rejoin it—that’s going to be very exciting. And I also think that the support and resource offered by high-quality information technology providers, will also make a huge difference, because they’ll help facilitate this shift. So your audience will be absolutely critical to the success of what I’m talking about.

We have to shift the incentives, or it will be unsustainable, correct?

Well, there’s finally a process to help us possibly compete with some peer nations around the world. And other nations focus more on the front-end aspects of care in ways we’ve never done. And when I thought about where we could justify training programs, it would be around deployment into these primary care arenas, so that’s why we focused on the VA medical centers, school-based health centers, and community-based health centers.

Is there anything else you’d like to add?

I do believe, thankfully, that there’s beginning to be an acceptance of the idea that the ACA is here to stay. It particularly concerned me, the effect that some of this debate and the constant calls for appeal, etc., were having on practitioners who were ready to embrace the reforms of the ACA and bring their expertise, and recognize that reform would be disruptive, but you had all this rhetoric about repeal, and it was fair for them to hesitate. And I think it was good that we’ve passed that, and we’ll benefit tremendously from providers’ ideas that will become part of reform.