[Congressional Record Volume 143, Number 18 (Wednesday, February 12, 1997)]
[Extensions of Remarks]
[Pages E230-E231]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       PRIMARY CARE EDUCATION ACT

                                 ______
                                 

                      HON. JAMES A. TRAFICANT, JR.

                                of ohio

                    in the house of representatives

                      Wednesday, February 12, 1997

  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--Dept. of Health and

[[Page E231]]

Human Services. To reverse current trends in medical education and 
lower the rate of inflation on health care costs, I have introduced 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. The Primary 
Health Care Education Act 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] eighth report to 
Congress and the Department of Health and Human Services called Patient 
Care Physician Supply and Requirements: Testing COGME Recommendations.
  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. The 
Primary Health Care Education Act 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 is 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 
pursue 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 work force 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. 
By comparison, current projections show that America will have a mix of 
31 percent generalists and 69 percent specialists by 2000--under the 
status quo.
  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 the act, 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. 
The Primary Health Care Education Act 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 work force needs of the 21st 
century.
  The Primary Health Care Education Act has been endorsed by the 
American Osteopathic Association and the American Association of 
Colleges of Osteopathic Medicine. If you support improved access to 
services and lower health care costs, I urge you to cosponsor the 
Primary Care Education Act.

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