Making the Case for Family Medicine in the North Carolina Legislature

ADVOCACY

By Gregory K. Griggs, MPA, CAE

NCAFP Executive Vice President

~ Working for You ~ Making the Case for Family Medicine in the NC Legislature

In early April, I had the privilege to represent our state’s family physicians before the NC Joint Legislative Oversight Committee on Access and Coverage. The committee is examining the possibility of finally expanding Medicaid in North Carolina but added a few thorny issues to the discussion, including Certificate of Need laws, scope of practice for Advanced Practice Registered Nurses, and more.

While I technically presented on a day dominated by Certificate of Need (CON) discussions, I focused on the benefits that Family Medicine brings to our state, economic realities that all family physicians face that are exacerbated in rural and underserved areas, and a few solutions that the NC General Assembly should consider.

To open the presentation, I took the opportunity to remind the legislative committee what Family Medicine truly is: providing continuous and comprehensive health care for the individual and the family. I described Family Medicine as the specialty of breadth encompassing all ages, genders, organ systems and disease entities. I went on to outline the benefits of Family Medicine: lower cost, improved quality, and better outcomes. I noted that individuals with a primary care physician have lower death rates of cancer, heart disease and stroke, and 33 percent lower healthcare cost than adults without a family physician. Additionally, in North Carolina, family physicians are more geographically dispersed than any other healthcare profession. In other words, Family Medicine truly is the solution to what ails our healthcare system.

Throughout the presentation, I discussed the maldistribution of physicians in North Carolina by geography and specialty, noting that not all specialties have shortages, and the state needs to invest more in producing the right specialties to practice in the right geographic regions, especially Family Medicine. Most importantly, I outlined some of the reasons that this maldistribution exists today.

First, the rate of uninsured adults in a county and the mix of payers has a direct impact on the economic viability of practice in that county. For example, the ten counties with the lowest rate of uninsured adults have 50 percent more primary care providers per 10,000 residents than the ten counties with the highest rate of uninsured adults. While Medicaid expansion would do so many things to improve the health of the individuals who would receive health insurance, it also would help the economic viability of practicing in our rural and underserved areas. Thanks to NCAFP Medical Student Director Morgan Carnes, who will be graduating from the Wake Forest University School of Medicine about the time this article appears, for her efforts in correlating the uninsurance rate with the rate of primary care providers by county.

Second, pay disparities matter. During the presentation, I pointed out that healthcare professionals in primary care earn over 50 percent less than their sub-specialty colleagues. Family physicians, general pediatricians, general surgeons, and psychiatrists are among the most needed specialties especially in rural North Carolina. It’s not surprising that they are also among the lowest paid specialties.

Third, debt burden matters. In 1978, the average debt of a medical school graduate was $13,500 (or about $53,000 adjusted for inflation). Today, the average medical school graduate has well over $200,000 in student debt, a 400 percent increase.

Finally, I highlighted other factors that impact special-

ty choice and particularly practice location choice, including: growing up in a rural area; early and frequent exposure to community practice, particularly in rural and underserved areas; and yes, financial incentives to practice in rural and underserved areas.

I wrapped up my presentation to the Joint Legislative Oversight Committee on Access and Coverage with a call for a sustained and comprehensive approach to overcoming healthcare professional shortages and distribution issues, offering solutions that the General Assembly should consider:

• Expanding Medicaid to provide coverage for the uninsured and help overcome one economic obstacle to practice in our rural and underserved areas.

• Greater overall investment in Family Medicine specifically and primary care in general. States that increase their investment in primary care ultimately have lower overall healthcare costs.

• Tying class size increases for our state’s health professional schools to outcomes (placing physicians in needed specialties in areas of the state that have the highest need for physicians).

• Funding for increased rural training sites to provide greater exposure to medical students earlier in their education.

• A rural scholarship program to cover medical school tuition up front in

See 'Making the Case' on back cover

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continues on Back Cover