The American Association of Medical Colleges estimates that we will have a shortage of 4000-30,000 primary care doctors by 2025. Even now, 45 states have fewer psychiatrists for their population than they had in 2009, despite well-publicized epidemics of opiate addictions and suicide around the country.
I work in a Community Health Center (CHC) with a team of other doctors, PAs (physician assistants) and NPs (nurse practitioners), dentists, licensed therapists and psychologists. Our 13 clinics in northeastern Colorado provide more than 74,000 patient visits per year. We provide medical, dental and mental health services to people of all ages, with a focus on low-income and underserved populations, including migrant farm workers. Many of us came to work in a CHC because of scholarships and loan repayment provided by the National Health Service Corps (NHSC), which paid for 3 years of my medical school in exchange for 3 years of full-time employment in an FQHC (Federally Qualified Health Center). After completing my three years of payback, I have worked another fourteen years in Community Health Centers.
Map courtesy of HRSA.
Among the many other more dramatic changes in President Trump’s proposed budget are deep cuts to the budget for the Health and Human Services Administration (HRSA), which administers the NHSC scholarship program. Graduates of the NHSC provide medical care in the areas of most shortage, including CHCs/FQHCs and FQHC-lookalikes in inner-cities and rural areas, correctional facilities, immigration holding centers, Indian Health Service clinics and Tribal Hospitals, migrant clinics, school-based clinics, community mental health facilities and critical access hospitals, all of which provide care regardless of a patient’s ability to pay. 10,400 current providers (and an uncounted number of post-NHSC alumni like me) provide care to 23 million of Americans who otherwise would have little-to-no access to health care, either because of geography, incarceration or poverty.
President Trump’s current budget proposes $400 million less for the NHSC and programs to train medical students and nurses in primary care. President Trump has called these programs “ineffective,” a statement which disregards years of research which has shown how effective community health centers (CHCs) are. Despite the fact that most CHC patients are typically more complicated than patients in an office-based practice,
- CHC patients in Colorado use the emergency room for health care 1/3 less often than patients served by other providers.
- CHC patients in California spend 25% fewer days in the hospital than patients of other providers, and have 64% fewer multiple-day hospital stays.
- CHC patients in North Carolina have 62% lower health care spending than patients of other providers.
- a medical visit for a CHC patient in Texas costs $384 less than a visit to an office-based physician.
- Michigan’s CHCs save $144 per Medicaid patient each year
- CHCs save 23% per Medicaid patient, and 11-34% per Medicare patient each year.
Community Health Centers save $24 billion in health care every year. Cutting the program that funds the training for and administration of this network is short-sighted and ill-advised. Community Health Centers save both lives and money. Let your Representative and Senators know how important your state’s CHCs are to your state.
Learning As We Go 