Advisory Committee on Training in Primary Care Medicine and Dentistry

Approved on October 21, 2008

Minutes of Audio-Conference Meeting, September 15, 2008

Advisory Committee Members Present
Lolita M. McDavid, MD, MPA, Chair
Perri Morgan, PhD, PA-C, Vice Chair
Lauren L. Patton, DDS, Vice Chair
Nathaniel B. Beers, MD, MPA
James F. Cawley, MPH, PA-C
Kevin J. Donly, DDS, MS
Mary B. Duke, MD
Katherine A. Flores, MD
Stephanie L. Janson, PA-C
Desiree Lie, MD, MSEd
Eugene Mochan, DO, PhD
Charles P. Mouton, MD, MS
Stephen C. Shannon, DO, MPH
Harry Strothers III, MD, MMM
James A. Thomas, PhD
Surendra K. Varma, MD

Others Present
Jerilyn K. Glass, MD, PhD, Acting Executive Secretary, Advisory Committee
Sanford J. Fenton, DDS, MDS, Retired Member
Joseph L. Price, PhD, Retired Member
Claire Wilson, Contract Writer, Insight Policy Research, Inc.

Monday, September 15, 2008

The Advisory Committee on Training in Primary Care Medicine and Dentistry (Advisory Committee) convened its audio-conference meeting at 10:00 a.m. Eastern Time.  Lolita M. McDavid, MD, Chair, began the meeting by having new members, current members, and guest retired members introduce themselves.

Dr. McDavid introduced Ms. Brenda Williamson, Chief, Primary Care Medical Education Branch in HRSA’s Division of Medicine and Dentistry, who provided an update on the most recent Title VII, section 747 grant cycle.  She provided data on the number of grant applications received, number that met eligibility requirements, number that were funded by grant category, and the amount of money awarded.

The Advisory Committee discussed plans for its 8^th report on the redesign of primary care and consequent implications for training and plans for the November 17-18 face-to-face meeting.  Surendra K. Varma, M.D. mentioned that the American Board of Pediatrics and the Accreditation Council for Graduate Medical Education have developed an R3 project allowing for a variety of activities within a pediatric residency.  Dr. Varma will provide some background materials on the project and give a review of it at the next meeting.

Challenges for the future of health care include the transition of large numbers of children with chronic conditions who when they reach adulthood will need to be cared for in adult practices.  Dr. Varma pointed out as another issue the number of conditions now being seen in the pediatric population that were previously diseases of adults, like hypertension and type II diabetes.  Perri Morgan, Ph.D., PA-C underscored the increased complexity of patients in primary care and the need for collaboration with specialists. 

Dr. McDavid discussed the need for children with chronic and special needs to get access to pediatric dentistry.  Mary Duke, M.D., felt that the medical-dental home concept cannot be explored without addressing the shortage of residents wanting to enter the primary care workforce. 

Dr. Morgan suggested that report recommendations be written to focus on inter-professional education and team communication.  Eugene Mochan, D.O., Ph.D., said that the issues could be brought together with a training model such as the Wagner Chronic Care Model.  Dr. Mochan will provide information to the membership about the model and will lead discussion on it at the next meeting.

James F. Cawley, M.P.H., PA-C, said that the decreasing number of physicians and physician assistants going into primary care can be directly tied to students’ rising debt levels.  One report recommendation might be to restructure the system such that educational subsidies can be given to reduce student debt.  The situation is especially critical because physician assistants are no longer coming to the rescue in terms of providing primary care; they, too, are following the same kinds of specialty distribution trends as graduating medical students.  Dr. Morgan is finishing a paper on this topic and will share the data at the November meeting.  Mr. Cawley will supply the latest data from the American Association of Physician Assistants and help lead the discussion in November.

Kevin J. Donly, D.D.S., M.S., said that dentistry is facing many of the same problems as medicine.  Especially critical is the extreme need for dental faculty.  Last year there were 357 unfilled positions in dental education.  The average age of a dental educator right now is 57-1/2 years.  One report recommendation might be for Title VII, section 747 to award faculty development grants in general and pediatric dentistry. 

The Advisory Committee discussed possible speakers for the November meeting.  The members who volunteered previously for the 8^th Report Writing Group were:  Dr. Morgan, Dr. Varma, Dr. Mochan, Katherine A. Flores, M.D., William A, Curry, M.D., and Sheila H. Koh, D.D.S., R.N.  New members to the Advisory Committee were invited to join the Writing Group.

The agenda turned to the finalization of the 7^th report on primary care serving as a medical-dental home for patients and communities.  The Advisory Committee discussed which of two titles they wanted for the report.  A vote will be taken electronically to select the title before the next meeting.

Dr. Donly led the discussion about the 7^th report.  He led the members section by section through the Report and explained what changes were made and why.  The Committee approved the report text and its recommendations.  The next steps are sending it out for public comment to constituent groups and getting it edited. 

Prior to meeting adjournment, there was time allotted for public comment.  There were no public comments.