Medicare Cuts will Accelerate Looming Crisis in Patient Access to Primary Care

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 20 Nov 2005 - 12:00 PDT

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Medical students and young physicians are turning away from careers in primary care medicine, and Congress must act now to stabilize Medicare payments to physicians as a first step to avert the looming crisis in patient access to primary care that this will cause.

These were the conclusions of Vineet Arora, MD, MA, chair of the Council of Associates of the American College of Physicians (ACP) and a member of the College's Board of Regents, who testified this morning in front of the House Energy and Commerce Committee, Subcommittee on Health on the impact of Medicare payment cuts on access to primary care.

Dr. Arora was invited to testify to share the views of a physician at the beginning of her career. She expressed that, from her perspective as a young physician, in the future it would become even more difficult to recruit new physicians into primary care medicine if the, already disproportionately low, Medicare payments to physicians were cut .

Right now, physician payments under Medicare will be cut by 4.4 percent on January 1, 2006. Additional cuts will decrease physician reimbursement by more than 26 percent from 2006 to 2011. According to the Medicare Economic Index from CMS, physician costs will rise by 15 percent during this same time period.

There is growing evidence that shortages are developing for U.S. physicians, particularly in general internal medicine and family practice. Current projections indicate that the future supply of primary care physicians will be inadequate to meet the health care needs of the aging U.S. population, especially as the baby boomers are beginning to reach retirement age in 2011, when they will be at increased risk for needing health-care services.

"We are the new generation of physicians that your elderly and disabled constituents will be counting on for their primary care," said Dr. Arora. "Unfortunately, there won't be enough of us. A combination of high student debt and an unfavorable economic environment is causing many of us to choose careers other than general internal medicine or family practice-the two specialties that aged and disabled patients most depend on for their primary care."

According to the Centers for Medicare and Medicaid Services (CMS), in 2004 almost half of all Medicare expenditures on office visits were for services provided by primary care physicians. Dr. Arora testified that Medicare payment cuts that will result from the flawed Sustainable Growth Rate (SGR) formula will accelerate this looming crisis in access to primary care.

In order to draw attention to the intensified problem these payment cuts cause for primary care physicians, ACP's testimony was prepared in conjunction with the American Academy of Family Physicians and the American Osteopathic Association, who also submitted their own statements. In addition to preparing this testimony together, last week these three organizations also jointly participated in a series of visits to members of both the House and Senate to highlight this issue. Combined, the three organizations represent approximately a quarter-million physicians and medical student members.

"Medical students and young physicians learn early on in our training about the joys of having a continuous, ongoing and personal relationship with a patient, which is the hallmark of general internal medicine and family medicine," said Dr. Arora. "Unfortunately, we also learn that primary care is under-reimbursed compared to other specialties, and that many primary care physicians are struggling financially. It is so bad that many of the excellent primary care physicians that we meet in our training programs go as far as to counsel us not to go into primary care. Why? Because they tell us that there is no economic future in primary care."

Dr. Arora is the Associate Program Director for the Internal Medicine Residency Program and the Assistant Dean for the Pritzker School of Medicine in Chicago. She also serves as an Instructor of Medicine in the Section of General Internal Medicine and as the Assistant Dean for Curricular Innovation in the Office of Medical Education.

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 119,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.

American College of Physicians

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