Primary care impacted by health care reform


As President Obama signed the health care bill on Tuesday, he put into law provisions that family doctors say will save primary care.

"We cannot recruit new primary care doctors to San Francisco or many other areas in California. It's a real problem," San Francisco doctor Robert Margolin said.

Margolin says Medicare and Medi-Cal reimbursements for primary care have been woefully underfunded for years and that's had a dramatic impact at medical schools.

"Right now for example at our medical school at University of California San Francisco, less than 10 percent of the graduates go into family medicine. We need that to be 30 or 40 percent going into family medicine and other primary care fields," Dr. Kevin Grumbach from UCSF School of Medicine said.

Grumbach says out of 155 medical students at his school, only 12 went into primary care. He worked on putting together the president's health care proposals, including a 50 percent increase in Medi-Cal reimbursements for primary care over the next five years.

"There's more money to invest in training programs in primary care, there's more money for things like loan repayment for primary care if you are willing to work in an underserved setting," he said.

And Grumbach says it's already leading to more medical students choosing to be family doctors.

At the Marin Community Clinic in San Rafael, which serves low income and under-insured patients, the increase in Medi-Cal and Medicare reimbursements means lower costs for their clients.

"I think the government is speaking for the people is saying health care is a priority," Marin Community Clinic director Jean Maki said.

"This is going to markedly increase the primary care physician's ability to take care of Medi-Cal patients. It's going to markedly improve their health care," Margolin said.

The increases in primary care reimbursements in the legislation are coupled with cuts to some specialties -- as much as 21 percent. Grumbach thinks Congress will reduce that number.

"But I think there will be a shift to re-distribute some funds from highly paid specialists to primary care physicians who've been relatively much less well compensated. And I actually think that's quite OK," he said.

The need for more primary care physicians is going to increase dramatically, as more people are covered by health insurance and presumably we'll be seeing a doctor more regularly.

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