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Government Funding; Health Reform; Testimony Transcripts


This testimony by Fitzhugh Mullan, M.D., addresses the following issues:

  • Improving access to health care in the United States will require modifications in the U.S. health care workforce, the foremost of which will be the construction of a strong primary care base.
  • Two-thirds of the U.S. physician workforce practice as specialists and the number of young physicians entering primary care is declining.
  • The distribution of health care providers in the U.S. heavily favors urban areas. Metropolitan areas have 2-5 times as many physicians as non-metropolitan areas and economically disadvantaged areas have significant health care access problems.
  • Today's physician-to-population ratio is in the zone of adequacy and should be maintained with growth in the number of physicians trained to parallel growth in the population. Increased requirements for patient care due to the aging of the population or the inclusion of more Americans in a universal care plan should be met by more strategic distribution of physicians, both geographically and across the primary care – specialty spectrum, and the expanded use of physician assistants and nurse practitioners.


  • Medical schools – Medical schools are currently expanding, and Title VII legislation needs to be reinvigorated and up-funded to augment primary care training.
  • Graduate Medical Education – The current number of Medicare funded slots is sufficient to maintain workforce numbers. However, reforms need to be made in current legislation to prioritize and incentivize community-based and primary care training. Serious consideration also needs to be given to aligning Medicare GME with the workforce needs of the country. This would entail designing a new GME allocation system.
  • Medical Practice – Primary care payment reform, support for new practice organizations such as primary care medical homes, and investment in health information technology are all important reforms that will promote a strong primary care practice base in the country.
  • National Health Service Corps – The NHSC is a proven program that delivers primary care clinicians to needy communities in return for student debt reduction. It is a brilliant and successful strategy that has always been under funded. It is time to radically increase its budget toward the end of fully staffing Community Health Centers and addressing the oncoming needs for clinical service in the U.S.
  • Teaching Health Centers – Establishing stable funding for both undergraduate and graduate medical education in health centers will promote a workforce prepared with skills needed for practice and improve recruitment and retention for health centers, which are critical providers of health care to underserved communities.
  • Data and leadership in the field of U.S. health workforce development is insufficient. A National Health Workforce Commission would be an important asset at the federal level in managing health care workforce reform.


S. HRG. 111–656. U.S. Senate Committee on Health, Education, Labor, and Pensions, Round Table on Primary Health Care Access Reform.

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CHRG-111shrg49531.pdf (2730 kB)
Printed Record of Hearing: S. Hrg. 111-656

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