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Congress, for example, already has chopped about .25 billion from the ACA's new billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. health disadvantages to a number of causes, including the fact that Americans have "more limited access to primary care." Today, the United States is short about 16,000 primary care doctors — the very doctors (family practitioners, internists and pediatricians) who offer the treatments and preventive screenings that save lives and head off expensive emergency room visits and hospitalizations. It starts with huge medical school debts and ends with a doctor who is often overworked and underpaid.
In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts "catastrophic." A recent study by the Institute of Medicine and the National Research Council reports that, when compared with citizens of 16 other high-income democracies, including those of Western Europe, Japan and Canada, Americans not only die younger but have poorer overall health. While students may enter medical school wanting to practice primary care medicine, they graduate saddled with heavy debt — 0,000 is not unusual — which prompts them to switch to a more lucrative specialty.
En español l For years, Marcia Andrews visited the same internist in Washington, D. Then she turned 65, got her Medicare card and had to find a new doctor: Her internist was not accepting Medicare patients.
Primary care doctors are in such demand now that they can choose not to accept Medicare, whose reimbursements to physicians are lower than private insurance rates.
The approach most favored by experts at Harvard and elsewhere is to reshape traditional primary care: from a stream of patients waiting to see one harried doctor to a more efficient team practice in which patients with routine problems are seen by nurse-practitioners and physician assistants — trained specialists with master's degrees.
The team frees the doctor to spend more time with patients with more serious complaints.
Only one in five graduating internal medicine residents plans to go into primary care medicine, the Journal of the American Medical Association reports. » To make primary care a more attractive choice, medical experts are exploring a number of fresh ideas — from the more efficient team approach to shortening medical school training from four years to three.
Community health centers offer another form of primary care.
Nationwide, the centers serve 20 million patients a year using a team approach, and are open to all on a sliding fee scale.
This change could be as fundamental as the one that took place when most family doctors stopped making Marcus Welby-like house calls.
The Affordable Care Act encourages such a sea change, with provisions that aim to shore up and expand the country's ailing primary care system while still reducing costs.
"The population is getting older, so there's a greater need for primary care physicians.