[Congressional Record Volume 141, Number 6 (Wednesday, January 11, 1995)]
[Extensions of Remarks]
[Page E85]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


    INTRODUCTION OF H.R. 449, THE PRIMARY HEALTH CARE EDUCATION ACT

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                      HON. JAMES A. TRAFICANT, JR.

                                of ohio

                    in the house of representatives

                       Wednesday, January 11, 1995
  Mr. TRAFICANT. Mr. Speaker, it's a well-known fact that America's 
growing emphasis on specialization in the physician work force has 
driven up the costs of health care and fragmented access to medical 
services. What is not widely known is that America will have a shortage 
of 35,000 primary care physicians by the year 2000 and a projected 
surplus of 115,000 specialists--Department of Health and Human 
Services. To reverse current trends in medical education and lower the 
rate of inflation on health care costs, I have introduced H.R. 449, the 
Primary Health Care Education Act.
  In the past year, two separate Government-funded studies have 
produced substantial evidence that medical schools must respond now to 
compensate for our primary care needs of the 21st century. H.R. 449 is 
based on the findings and recommendations to the Congress found in both 
reports. These reports include: First the General Accounting Office's 
[GAO] October 1994 report to congressional requesters entitled 
``Medical Education: Curriculum and Financing Strategies, Need to 
Encourage Primary Care,'' and second, the Council On Graduate Medical 
Education's [COGME] fourth report to Congress and the Department of 
Health and Human Services entitled ``Recommendations to Improve Access 
to Health Care Through Physician Workforce Reform.''
  At this time, I would like to briefly summarize the GAO's findings. 
Medical career decisions are usually made at three specific times 
during a student's education: First, at the end of college when 
students typically apply to medical school, second, during the fourth 
year of medical school when students choose the area of medicine to 
pursue and enter residency training, and third, at the end of residency 
training when residents decide to enter practice or to train further 
for a subspecialty. H.R. 449 attempts to encourage primary care as a 
career choice at all points in a student's academic career.
  The choice of career paths in medicine were found to be significantly 
influenced by the curriculum and training opportunities students 
receive during their medical education. Foremost among these factors 
was whether the medical school had a family practice department. 
Students attending schools with family practice departments were 57 
percent more likely to pursue primary care than those attending schools 
without family practice departments. Second, the higher the ratio of 
funding of a family practice department in relation to the number of 
students, the higher the percentage of students choosing to enter 
primary care. Students attending medical schools with highly funded 
departments were 18 percent more likely to pursue primary care than 
students attending schools with lower funding. A third factor was 
whether a family practice clerkship was required before career 
decisions were made in the fourth year. Students attending schools 
which required a third-year clerkship were 18 percent more likely to 
purse primary care. Fourth, a significant correlation was found between 
residents who were exposed to primary care faculty, exposed to hospital 
rounds taught by primary care faculty, and exposed to rotations which 
required training in primary care--and residents who were not--in 
choosing to enter general practice.
  Given the health care needs of the 21st century, COGME recommends we 
attain the following physician workforce goals by the year 2000. First 
year residency positions should be limited to the number of 1993 U.S. 
medical school graduates, plus 10 percent. At least 50 percent of 
residency graduates should enter practice as primary care physicians. 
And, steps should be taken to eliminate rural and inner city primary 
care shortages.
  To reverse the current trends toward specialization, the Traficant 
Primary Care Education Act directs the Secretary of Health and Human 
Services to give preference to medical schools which have established 
programs that first, emphasize training in primary care, and second, 
encourage students to choose primary care. Under H.R. 449, the 
Secretary must consider the GAO's findings when establishing the 
conditions a medical school must meet to receive preference.
  The Secretary, however, is by no means limited to the GAO's findings. 
H.R. 449 was designed to give the Department of Health and Human 
Services the authority to shift the current trends in medical education 
to meet existing and future needs. It does this by giving preference, 
or awarding grants and contracts to schools which have designed 
curriculum that has been proven to increase primary care. The Traficant 
bill, however, by no means dictates, to the administering agency or 
medical schools, the best way to achieve the desired results. The 
Traficant bill, in fact, follows the intent of language of the Public 
Health Service Amendments of 1992, which was passed only by this body. 
It is my hope that HHS, as the expert agency on this issue, in 
consultation with medical schools, GAO, and COGME, will attain the 
health care and physician workforce needs of the 21st century.
  If you support improved access to services and lower health care 
costs, I urge you to cosponsor H.R. 449, the Primary Care Education 
Act.


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