Advisory Committee on Training in Primary Care Medicine and Dentistry

Minutes of Meeting, May 7-8, 2008

Advisory Committee Members Present
Lolita M. McDavid, MD, MPA, Chair
Perri Morgan, PhD, PA-C, Vice Chair
Lauren L. Patton, DDS, Vice Chair
James F. Cawley, MPH, PA-C
Diego Chaves-Gnecco, MD, MPH
William Alton Curry, MD
Kevin J. Donly, DDS, MS
Sanford J. Fenton, DDS, MDS
Katherine A. Flores, MD
Karen A. Gunter, MS, PA-C
Bonnie Head, MD
Sheila H. Koh, DDS, RN
Eugene Mochan, DO, PhD
Charles P. Mouton, MD, MS
Joseph L. Price, PhD
Barbara J. Turner, MD, MSEd
Surendra K. Varma, MD

Others Present
Marilyn Biviano, PhD, Director, Division of Medicine and Dentistry
Jerilyn K. Glass, MD, PhD, Acting Executive Secretary, Advisory Committee

Wednesday, May 7, 2008

The Advisory Committee on Training in Primary Care Medicine and Dentistry (Advisory Committee) convened its meeting at 8:40 a.m. at the Hilton Rockville Executive Meeting Center, 1750 Rockville Pike, Rockville, MD 20852.  At the opening of the meeting, Lolita M. McDavid, MD, Chair, said that the business of the day would be work on the Advisory Committee’s seventh report.  After members introduced themselves, Dr. McDavid introduced Marilyn Biviano, PhD, Director of HRSA’s Division of Medicine and Dentistry, who applauded the Committee’s work on the medical/dental home concept.  She provided an update on recent Bureau meetings including its All Programs Meeting in February 2008 and the Council on Graduate Medical Education (COGME) which has completed reports on new paradigms for physician training and greater flexibility in graduate medical education. 

Barbara J. Turner, MD, Co-Chair of the Seventh Report Writing Group, presented the work done by the Writing Group since the last meeting.  She raised the issue of cost as it relates to the medical/dental home concept and said that it was important the Advisory Committee not promise that implementation of the medical/dental home concept is going to be a solution to the Nation’s economic crisis in health care.  She urged an examination of the needed underpinnings in training if the concept is to be successfully taught.  She believed that the report needed more reality in the discussion on principles underlying the medical/dental home concept.  The Advisory Committee decided to include a matrix in the report that would align medical home principles with the Accreditation Council for Graduate Medical Education (ACGME) competencies.  William Curry, M.D. and Surendra Varma, M.D. agreed to work on such the matrix.  Perri Morgan, Ph.D., PA-C urged a broader focus on primary care so that dentistry is not forgotten.  Dr. McDavid stressed that the report should indicate why Title VII, section 747 funds are so important and how those funds are used. 

Among the Advisory Committee’s suggested changes for the draft seventh report were clarification that the seven principles of the medical/dental home be viewed as an ideal vision rather than a guaranteed solution, less emphasis on the potential cost savings of a medical/dental home because the cost may be more initially, and added discussion on the obesity epidemic and its association with chronic illness.  Other suggestions included the addition of information on income gaps between primary care physicians and specialists within the context of a projected physician shortage in primary care, more evidence for prevention and what preventive care means in terms of cost savings, and a new section on the effectiveness of multidisciplinary teams.

In discussing the recommendations, the Advisory Committee stressed that the Nation needs to strengthen the primary care base of the health care system.  It felt that an expansion in funding was needed for demonstration projects that incorporate team approaches to health care.  It stressed that any solution to the shortage of primary care providers will require a solution to the overwhelming debt that medical, dental, and physician assistant students have when they graduate from training programs.  Several members offered additional recommendations for consideration.  The members reviewed and made changes to the wording of the various recommendations. 

The plan is to have the Seventh Report Writing Group continue its work via conference call through the summer and once it is ready, have it sent out for public comment. 

The Advisory Committee took up the topic of the next report.  The eighth report was seen as building on the seventh report by focusing on the redesign of primary care delivery.  The medical/dental home would be just one way of redesigning primary care.  As pointed out by Dr. McDavid, primary care is the “door to all of medicine” because it is the primary care physician, physician assistant, and dentist who most often see a patient first and determine whether a referral is in order. 

With a growing shortage of primary care physicians and the increasing prevalence of chronic disease, there is a demand for a new model of health care delivery.  Heightened attention is being focused on primary care’s role in a new system and the appropriate training of primary care health professionals to meet new responsibilities.  The key question becomes how training, especially Title VII, section 747, will respond to the redesign in primary care.  The Advisory Committee sees the strengthening of Title VII, section 747 training as the centerpiece of its eighth report because Title VII, section 747 is the engine for making a change in the way medicine and dentistry are practiced.  This training will address evidence-based medicine and practice, the new role of information technology, reimbursement issues and reform, prevention, and training in how to work in an interdisciplinary manner.       

The members who volunteered to serve on the Eighth Report Writing Group were Katherine Flores, M.D., Dr. Morgan, Dr. Varma, Dr. Curry, and Eugene Mochan, D.O., Ph.D. 

During the public comment period, Stephen Shannon, D.O., President of the American Association of Colleges of Osteopathic Medicine urged the Advisory Committee to collaborate with other groups to focus attention on the policy issues surrounding the health care workforce.  He suggested attention on primary care training for a health care world in a time of shortage. 

The meeting adjourned at 4:13 p.m.

The following day, May 8, the Advisory Committee joined the members of three other advisory committees within the Bureau of Health Professions for an All Advisory Committee Meeting.