Cantwell offers booster shot for primary-care MDs

YAKIMA, Wash. -- Jon Smiley, chief executive of Sunnyside Community Hospital, needs to recruit five primary-care physicians -- two of them obstetricians -- between now and next year in order to meet expected demand.

But because of a nationwide shortage of primary-care doctors that is especially acute in rural areas, he's not sure where they are going to come from.

"That's a very big job for a small hospital," Smiley said.

He held out hope Wednesday that legislation to be proposed by Sen. Maria Cantwell, D-Wash., will make his job easier.

Elements of Cantwell's plan include helping recent graduates with their debt, getting them into training positions at smaller hospitals and reforming Medicare to value the work of primary-care medicine.

Cantwell was in Yakima to outline her two bills during a news conference at Pacific Northwest University of Health Services, which is training doctors who will hopefully stay in the Northwest and practice primary care. She said solving the primary-care doctor shortage is a critical part of the debate over health-care reform.

"If we truly want to improve access to care for Washingtonians while reducing costs for all, we must address how to improve access to care, how to increase the number of practicing primary care physicians, and how best to protect patients' relationships with their doctors," Cantwell said.

The Preserving Patient Access to Primary Care Act of 2009 would provide incentives for prevention-oriented care, which is more efficient than treating people after they've become sick with a chronic disease such as diabetes.

Medicare would be revamped to reward primary-care providers who manage their patients in a way that reduces unnecessary tests or visits to specialists, presumably removing incentives for medical-school graduates to move into higher-paying specialties.

More specifically, the bill would forgive loans for graduates who choose primary care and remove limits on the number of residencies funded by Medicare, giving preferences to primary-care trainees.

A medical student who spoke at Wednesday's news conference said help with some $250,000 in debt that graduates routinely face would be a big help to primary-care doctors who want to practice in smaller communities.

"The hours are long but at the end of the day I will be able to see the evidence of my work in a thriving community," said Jaime Klippert, who just finished her first year of medical school.

The Physician Workforce Enhancement Act would expand the nation's graduate medical-education training capacity to a larger number of suburban and rural hospitals -- not just the big urban teaching hospitals.

Hospitals that commit to starting new residencies in one of eight disciplines could get interest-free loans to offset the cost. The eight disciplines are family, internal, emergency and preventive medicine; pediatrics, general surgery, obstetrics/gynecology and behavioral and mental health.

Cantwell said $55 million in government savings generated from more preventive care would pay for the new measures.

* Leah Beth Ward can be reached at 509-577-7626 or lward@yakimaherald.com.