Should the Mayans have been wrong and we survive 2012, 2014 is approaching rapidly. Despite the belief among newspaper letter writers that providing healthcare is a form of communist income redistribution, the Affordable Care Act (or PPACA) is the law of the land, most of the provisions occur in 2014, and implementation will need to be planned. Unfortunately, suddenly providing health care to 30,000,000 Americans previously denied is not a simple as giving them an insurance card. The New England Journal of Medicine published an article that looks at America’s state of readiness for the impending increase in people who suddenly have access to healthcare. Not surprisingly, they found that America is not ready, southern states are less ready than most (Alabama is 41st out of 50 as it relates to readiness) and we have no plan for increasing readiness. They conclude:
Addressing the goals of health care reform will take a combined federal, state, and local strategy involving resource deployment and actions designed to expand the available short-term and long-term supply of well-trained primary care professionals who are ready and willing to serve the newly insured. Ensuring access to care will depend on our ability to achieve smart growth in both insurance coverage and primary care capacity.
There is one group that has looked beyond 2012. The Council on Graduate Medical Education has published a report entitled Advancing Primary Care, focusing on how physician training should be redeveloped given the new realities. The recommendations are as follows but I encourage you to read the report in its entirety:
1. The Number of Primary Care Physicians
Recommendation: Policies supporting physicians providing primary care should be implemented that raise the percentage of primary care physicians (general internists, general pediatricians, and family physicians) among all physicians to at least 40 percent from the current level of 32 percent, a percentage that is actively declining at the present time. The achievement of this goal should be measured by assessing physician specialty once in practice, rather than at the start of postgraduate medical training.
2. Mechanisms of Physician Payment and Practice Transformation for Primary Care
Recommendation: To achieve the desired ratio of practicing primary care physicians, the average incomes of these physicians must achieve at least 70 percent of median incomes of all other physicians (According to data from the Medical Group Management Association cited in the report, primary care physicians’ median annual compensation was $186,044 in 2008 versus $339,738 for physicians practicing in other specialties). Investment in primary care office practice infrastructure will also be needed to cope with the increasing burdens of chronic care and to provide comprehensive, coordinated care. Payment policies should be modified to support both of these goals.
3. The Premedical and Medical School Environment
Recommendation: Medical schools and academic health centers should develop an accountable mission statement and measures of social responsibility to improve the health of all Americans. This includes strategically focusing and changing the processes of medical student and resident selection and altering the design of educational environments to foster a physician workforce of at least 40 percent primary care physicians and a health system that meets societal needs.
4. Graduate Medical Education
Recommendation: Graduate Medical Education (GME) payment and accreditation policies and a significantly expanded Title VII program should support the goal of producing a physician workforce that is at least 40 percent primary care. This goal should be measured by assessing physician specialty in practice rather than at the start of postgraduate medical training. Achieving this goal will require a significant increase in current primary care production from residency training and major changes in resident physician training for the practice environment of the future.
5. The Geographic and Socioeconomic Maldistribution of Physicians
Recommendation: So long as inequities exist, policies should support, expand, and allow creative innovation in programs that have proven effective in improving the geographic distribution of physicians serving medically vulnerable populations in all areas of the country. This should be done through mechanisms such as the National Health Service Corps and Area Health Education Centers.
The Future of Family Medicine blog, found here, is created and maintained by medical students to support students who remain interested in Family Medicine despite all of the obstacles and hardships. They are excited. In the words of mdstudent31, these are exciting times
I do not know about you, but these are pretty bold recommendations and very exciting for the future of our great specialty.  Will these recommendations gain traction anywhere within the government?  While it is true that more primary care used appropriately and effectively decreases the amount spent on healthcare, will there actually be an increase in salary?  Or would we go as far as entering into the blasphemous territories of decreasing the median specialty salary?  ::GASP:: My guess is it would probably be a little bit of both.
I will concede that if we make it past 2012 we are in for exciting times.