Koeppen testifies before Senate Subcommittee on Primary Health and Aging
April 23, 2013 - Dr. Bruce Koeppen, founding dean of the Frank H. Netter MD School of Medicine, testified April 23 before the Senate Subcommittee on Primary Health and Aging on Successful Primary Care Programs: Creating the Workforce We Need.
Koeppen was invited by Committee Chairman Sen. Bernie Sanders and Ranking Member Sen. Richard Burr to testify about the Frank H. Netter MD School of Medicine, which admits its first class of 60 in August and was created with the mission to train primary care physicians, foster collaborative, team-based care and serve as a national model of interprofessional health professions education. It will eventually be the largest medical school in Connecticut.
Koeppen testified about the growing shortage of primary care physicians, and efforts to restructure the health care system to provide high quality, cost-effective and patient-centered care and successfully create the primary care workforce this country so desperately needs.
“Instituting major reforms in primary care and enabling people to see a doctor when they need one will save lives, ease suffering and allow our nation to save billions in health care costs,” Sanders said. “Medical schools are the training ground for the next generation of physicians, and schools must make a strong commitment to promote primary care at a time when the incentives drive the majority of students to choose a specialty. Schools such as Quinnipiac that find innovative ways to prioritize primary care will serve as leaders in developing the workforce we need.”
According to Koeppen, the challenges are daunting:
- 30 million additional Americans will enter the health care system because of health care reform;
- one third of current physicians are expected to retire;
- 17,000 primary care physicians are needed in underserved areas just to meet Health and Human Services’ target of one doctor for every 2,000 residents;
- and a tremendous wage gap exists for family physicians/internists compared to other specialties.
In fact, he notes The Center for Work Force Studies of the Association of American Medical Colleges (AAMC) projects a significant shortage of primary care physicians practicing family medicine, general internal medicine and general pediatrics. According to the AAMC analysis the shortage of primary care physicians in 2020 will be 45,400, increasing to 65,800 in 2025.
“We have 10,000 baby boomers per day--half of whom are already diagnosed with two or more chronic medical conditions-- entering the Medicare system, and more than 30 million individuals who will obtain health insurance through the Affordable Care Act,” Koeppen said.
“In the past, medical students have shied away from primary care because of the perception it is ‘less prestigious,’ more demanding, and at the bottom of the income ladder. But high quality patient-centered care is essential to the health of our citizens, especially for the nation to bend the health care expenditure curve. But, doing more of the same in terms of medical student education will simply not get us to where we, as a nation, and a health care system, need to be. We need new ideas and new approaches. I’m pleased that Quinnipiac University is at the forefront of these efforts.”
Koeppen said new medical schools are uniquely positioned to positively affect medical student education though the kind of innovation that might be difficult in established medical schools. “We aim to change the traditional model, where the physician is viewed as the captain of the ship giving orders to the crew, to a model more akin to a NASCAR pit crew, where a team of highly trained and skilled professionals each bring their expertise to a single goal: the care of the patient. “
Koeppen noted that the new medical school builds upon Quinnipiac’s strong programs in health sciences and nursing to educate diverse, patient-centered physicians who are partners and leaders in an interprofessional primary care workforce; responsive to health care needs in the communities they serve; and who work in collaboration with the University’s global health program. It has also established a Center for Interprofessional Healthcare Education, which serves as a think tank and coordinating point for identifying best practices for interprofessional education.
To achieve its goal, the school has hired faculty that support its mission; implemented a holistic student admissions process; developed a primary-care based curriculum; developed positive role models in primary care; and targeted financial aid issues.
The core curriculum is designed to emphasize high impact diseases, rather than the rare diseases that are more the domain of subspecialists. It also emphasizes wellness, prevention, social determinants of health, and health disparities.
Two unique components include a Medical Student Home (MeSH), where medical students spend time in a primary care physician’s office starting freshman year; and a concentration and capstone experience in either global, public, and community health; health policy advocacy; health management and leadership; health communication; medical education; medical humanities; or translational, clinical and basic science research.
Limiting debt for students tracking into primary care is key Koeppen says that when it is fully funded, Quinnipiac’s Primary Care Fellowship, established by its Board of Trustees, will waive tuition for every student who commits to practicing primary care at least four years after they complete their residency training.
According to Koeppen, resident physicians who start out on a path to a primary care career may be diverted during the course of their residency training. He says an effort must be made to embed residency programs into settings where high quality primary care is being provided. As a good first step, he cites the Affordable Care Act’s three year grant for the “Teaching Health Center” program, which allows Community Health Centers to establish residency programs to train physicians who would then stay on to practice primary care in that setting.
“We need to expand the number of federally funded residency positions in the country, and weight those toward primary care disciplines,” Koeppen said. “This is critical if we are to address the looming primary care physician shortage. We also need to change the perception that primary care medicine is boring and that only specialists see interesting cases. The real truth is those interesting patients often see the specialist by a referral from the primary care physician.
“If we establish primary care teams that consist of physicians, nurse practitioners, physician assistants, occupational and physical therapists, nutritionists, behavior health specialists, and states allow these individuals to practice at the top of their training, rather than at the top of their license, we will have an exciting and fulfilling work environment for all,” he added. “Most importantly patients will receive better coordinated, and a better quality of care and we will lower health care expenditures, by keeping patients well longer, and out of the hospital.”
Read Koeppen's testimony (Adobe PDF)