News and Commentary George Thibault on the President’s Budget Proposal

President Obama’s 2015 budget calls for major increases in funding to expand primary care, including doubling funding for the National Health Service Corps and increasing the number of residency slots for doctors wanting to work in primary care. Although the budget plan faces many hurdles in Congress, many of the policies in the President’s budget reflect recommendations that the Macy Foundation has been making for a number of years. President George Thibault reflects on the President’s budget and what it could mean for addressing the nation’s primary care shortages.

Q: What is the significance of President Obama’s call for investments in efforts to shore up primary care capacity?

These are all good signals. We have been recommending an increase in National Health Service Corps spending since 2010 when we held a conference on this topic to encourage careers in primary care and address the financial disincentives that keep students from entering this specialty area. Giving scholarships or debt relief to students and exposing them to experiences in community care settings are very important steps to getting more professionals to commit to primary care. More primary care training sites are needed along with new training positions, including in psychiatry where we have real shortages. We also support the plan’s recognition of the important role of physician assistants and nurse practitioners in helping to fill some of the void.

Q: Do you think this plan has a chance of passing?

Even if the President’s budget plan doesn’t pass in its current form, this is an important statement of values. I’m glad the President is putting it out there. It’s important to lay down the gauntlet.

Q: The President also recommends spending an additional $5 billion to train 13,000 primary care residents over the next decade. Is this an important policy change?

This is the first time since the 1997 Balanced Budget Act that the federal government is recommending that Medicare fund new positions for graduate medical education. That is something we endorse and see a need for. What concerns me though is that the plan doesn’t indicate where the dollars would come from to support this. I suspect they are redirected dollars. I doubt that the President is suggesting new money.

Q: Macy has been funding a lot of projects that reflect what the President is proposing, including promoting more team-based care. What are some of the lessons you’re learning?

We are learning that providing high quality experiences in primary care education will increase the likelihood that people will choose careers in primary care. We’re also learning that health professionals who are educated together will be more ready to work in teams. If we are going to fulfill the promise of the ACA, we have to have the right workforce. The ACA makes it all the more critical we focus on primary care because we are bringing more and more people into the health care system (which is good). We need the right kind of care and efficiency to take appropriate care of them. Even without the ACA, these changes would be highly desirable. The ACA only makes these changes more urgent.

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