How can communities ensure they have enough primary care physicians to keep their populations healthy and treat them when they are sick? In the past, the federal government was most directly involved in addressing this question by designating certain areas as needing more physicians and through loan forgiveness for physicians practicing in such areas. Recently, state and even local programs have joined the feds in trying to ensure their communities have enough physicians, particularly in primary care. This article discusses a federal, a state and a local program, and offers a note of caution about the multiplicity of programs.
If you are recruiting primary care physicians to town, whether on behalf of a group or a hospital or other entity, you may want to inform the physicians of the resources available to them, some of which are discussed below. While they may be aware of the federal and perhaps state programs, they will likely not be aware of local programs unless they’ve done quite a bit of research on your community. And, for many of the programs, you need to catch the physicians before they’ve moved to town since many are not available to physicians who have already begun practicing in the area. By informing physicians of the potential resources available to them, you likely build good will and strengthen their ties to your community as many of the programs have minimum work requirements attached to them.
The federal government recognizes that certain communities have physician shortages through its Health Professional Shortage Areas (HPSAs). These may be a geographic area, a population group, or a medical facility with a shortage of primary care, dental, or mental health providers. Designation as a HPSA has benefits, including one I run across as a health care attorney: allowing a hospital or group that is recruiting a physician to a HPSA to fulfill one element of the anti-kickback recruitment safe harbor. 42 CFR §1001.952(n). The federal government also identifies Medically Underserved Areas and Medically Underserved Populations.
The federal government has also been involved in redistributing physicians through its National Health Services Corps (NHSC) program, which began in 1972 to direct primary care physicians to communities lacking in such services. The NHSC provides three types of assistance: loan repayment for working in underserved areas, scholarships for those training in primary care and designation as an NHSC-approved site which provides those sites with access to primary care providers. Currently, participation in the NHSC is at an all-time high with more than 10,000 NHSC members providing care to over 10 million patients. To provide some perspective, the number of people participating in the NHSC has nearly tripled since 2008. Earlier this month, the NHSC awarded over $10 million for loan repayment to medical students who are training in primary care and agreed to serve communities who need them most. More details on this loan repayment program, which is a pilot program, may be found here.
In addition to NHSC (the grandfather of redistribution programs), states have become more involved in physician redistribution. New York began a program in 2008 called Doctors Across New York (DANY). Under the DANY program, physicians may apply for physician loan repayments, physician practice support, and certain health care providers may apply for funds to help recruit new physicians to underserved communities. Under all the DANY programs, the funds must go directly to the physician and may not be used for administrative expenses. The 2012-2013 New York budget mandated certain changes to the DANY program, including that awards would be made without a competitive bid process, the application process would be streamlined and made more clear and user-friendly, and applications would be open to New York state-operated facilities.
Now, individual communities are also looking to attract primary care physicians. In the Rochester region, the largest health plan, Excellus, is working with local hospitals and community health centers, with the backing of the Rochester Business Alliance, to attract more primary care physicians to the area. This program, which began in 2012 and is expected to last four years, is funded through a small surcharge on hospital bills that Excellus pays for its policy holders. To be clear, the patients will not pay for this surcharge. Through the surcharge, the four hospitals in town, along with the Rochester Integrated Health Network (RIHN), a grass roots organization with hospital and community health center representation on its board, are each going to distribute $120,000 to primary care physicians to attract them to the area to provide needed services. The four hospitals involved are Highland Hospital, Rochester General Hospital, Strong Memorial Hospital and Unity Hospital.
The program gives the four hospitals and RIHN flexibility in the awards. The entities may award the full amount to one physician or may choose to divide the amount between two or more physicians. And the primary care physicians do not have to work for a hospital or the RIHN to be eligible for this program. This innovative program has an insurer working with hospitals and – through RIHN – community health centers, with the backing of an employer group, to bring primary care physicians to town. See here for a summary of the program and contact information for the four hospitals and RIHN.
Note of Caution
As you inform primary care physicians of the various programs that may be available to them, one note of caution: be sure to tell physicians to investigate how the various programs may or may not interfere with one another. With so many new programs, the physicians (or perhaps you on behalf of the physicians) should ensure that accepting more than one relocation award does not make them ineligible for accepting another award. And if the awards are mutually exclusive, the physicians need to evaluate which are best for them, including which awards are the highest amount of money, which awards they have the best chance of receiving and what are the minimum time commitments associated with each award. A balancing of these criteria will help a physician choose between programs, should a choice be required.