A Manpower Policy for Primary Health Care Report of a Study (1978) / Chapter Skim
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Chapter 1: Introduction and Summary
Chapter 1: Introduction and Summary
Pages 1-14
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By 1976 the Congress declared, in the statutory preamble to the Health Professions Educational Assistance Act, that the availability of health care in general depends largely on the availability of primary care practitioners. Because appropriate manpower resources are essential to an effective primary care strategy, the Institute of Medicine undertook the study reported here to propose recommendations that would coordinate many important aspects of primary care manpower policy and to help assure that the development of that policy is based on appropriate information.
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An increase in programs to train physicians for primary care has been accompanied by increased interest in having coordinated care delivered by an interdisciplinary team of physicians, nurses, and other therapists who can provide diverse services to the patient. 2/ To supplement physician services and make primary care available to medically underserved populations, programs have been established with federal support to train nurse practitioners and physician assistants.
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This report therefore addresses not only such traditional manpower concerns as public funding of education, credentialing of practitioners, and qualitative and quantitative aspects of training programs, but also the scope of primary care services, their reimbursement, and health services research. These latter issues so deeply affect the use and supply of primary care manpower that they must be included, in the committee's judgment, in any comprehensive and integrated, primary care manpower policy.
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Statements by 18 organizations and individuals were presented at a one-day open meeting of the committee at the National Academy of Sciences in Washington, D.C., in January 1976. 8/ The committee met regularly to formulate a definition of primary care and to develop recommendations about the credentialing of primary care practitioners and their legal liability, the use and acceptance of nurse practitioners and physician assistants, and the financing of primary care services.
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Prototypes of primary care practice arrangements include single specialty units (including family physicians) , multispecialty units, family practice teams, and multispecialty teams.
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, for the present, the number of nurse practitioners and physician assistants trained should remain at _ the current annual level. Reimbursement strategies were considered as a method for making primary care practice more attractive to physicians.
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, training programs for family physicians, nurse practitioners, and physician assistants should continue to receive direct federal, _ ~ state, and private support, because these practitioners are the most feasible providers of Primary care to underserved populations. Also, some changes in reimbursement policies are advocated to encourage primary care practitioners to serve in shortage areas, although tile committee recognizes a dearth of available evidence linking reimbursement levels to physician location.
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Chapter 5: Education for Primary Health Care Practice Primary care education policy should assure both an adequate supply of primary care practitioners and levels of competency suitable for the task to be performed. At this time, major educational issues include percentage goals for primary care residencies, public support of primary care residency programs, the nature of primary care medical education and team training, and credentialing.
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Primary care is a vital feature of medical education because primary care, as defined by the committee, is the level of care at which the great majority of health problems is managed. Experience in primary care clinical settings can provide medical students with role models useful for leading the students into primary care careers.
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LEGAL LIABILITY OF PRIMARY CARE MANPOWER. A review of malpractice and other legal concerns affecting the use of nurse practitioners and physician assistants.
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PUBLIC PAYMENT FOR PRIMARY CARE SERVICES. A brief discussion at the issues in publicly reimbursing primary care physicians, nurse practitioners, and physician assistants.
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Nurse practitioner and physician assistant productivity data also are examined .
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See Chapters 2-5 and staff papers, "Education of Primary Care Practitioners," '~Data on the Supply and Distribution of Primary Care Physicians," "A Compilation of Data on the Content of Primary Care Practice," "Data on the Roles of the Physician Assistant and Nurse Practitioner," and "Licensure of Primary Care Practitioners." 7. See Chapter 2.
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From page 14... ...
8. Each organization or individual invited to the open meeting was asked to submit a paper suggesting references, areas of inquiry, and important policy considerations.
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