Addressing the Shortage of Primary Care Physicians

Addressing the Shortage of Primary Care Physicians

Thursday, September 25, 2008


event: conference call on the Shortage of Primary Care Doctors and Wage Enforcement

WHAT: Conference call to discuss promoting wage enforcement laws as an alternative to anti-immigrant proposals
WHEN: Thursday, September 25, 2008, 2:00pm EDT
WHO: Sen. Joe Bolkcom, Iowa State Senator
Cathy Ruckelshaus, Legal Co-Director, National Employment Law Project (NELP)
Patricia Smith, New York Department of Labor
Nathan Newman, Policy Director, Progressive States Network
Caroline Fan, Immigrant and Workers' Rights Policy Specialist, Progressive States Network
DIAL-IN: (800) 391-1709, Login Code 709424



Addressing the Shortage of Primary Care Physicians

According to The Boston Globe, a national shortage of primary care doctors is hitting Massachusetts especially hard.  The state's 2006 health insurance mandate has resulted in an additional 439,000 newly insured residents trying to seek care from an already over-stressed medical profession.  According to an annual survey by the Massachusetts Medical Society, wait times for new patients to see primary care doctors are running an average of 50 days, though some doctors report delays up to 100 days.

In order to increase the number of primary care doctors, the state legislature passed a number of financial incentives that focus on medical school debt forgiveness in order to attract more primary care doctors to the profession.  The incentives, part of a broad cost containment bill enacted this year, include:

  • $1.5 million to expand class size and increase enrollment at the University of Massachusetts Medical School,
  • Waiving tuition and fees for students who work as primary care doctors in the state for four years following medical school,
  • $1.7 million to repay school loans of doctors who work in community health centers, and
  • $500,000 to pay of debt for doctors who practice in under-served communities for at least two years.

As the Globe reports, a loan repayment program started last year with a $5 million grant from Bank of America plus $1.7 million in state funds has so far resulted in an additional 45 doctors and 19 nurse practitioners working in community health centers for two to three years.  The Massachusetts Medical Society is also urging action on payment reform and reducing the administrative burden on doctors.

A Nursing Shortage, Too: Elsewhere, as reported by, a nationwide nursing shortage has prompted more than two-thirds of states over the past five years to pass nursing education programs and increase funding for nursing scholarships and loan forgiveness programs.  According to the report, the US is projected to face a shortage of 1 million nurses by 2020.  Along with nurse retirements and a shortage of nursing teachers, another reason for the decline is workplace problems in hospitals, such as mandatory overtime and requiring nurses to care for too many patients, which put nurses and patients in jeopardy.

According to the report, to improve workplace conditions 14 states have acted to ban or limit mandatory overtime and 13 states require hospitals to establish committees to determine staffing needs.  In California, nurses are limited to caring for five patients at a time.

Solutions to Medical Debt and Shortages: The American Medical Student Association (AMSA), has 67,000 members and advocates before Congress advocating for solutions to the crippling debt, averaging $140,000, that greets students upon completing medical school, as well as other issues of concern to the medical community.  As AMSA explains, medical school debt is a particular barrier for physicians of color and for physicians choosing to work in under-served areas.  Yet recent federal legislation will drastically reduce the number of students eligible for debt assistance.

To make primary care more attractive to new physicians and to improve the diversity of the health care workforce, AMSA advocates for robust initiatives to help students manage or eliminate their medical school debt.  These include low interest loans, a cap on the rise of state medical school tuition, loan deferment programs, and full reauthorization of the National Health Services Corps, which is akin to AmeriCorps for the medical community and helps encourage students to enter the primary care field.

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Paid Sick Days on Ballot in Milwaukee

Milwaukee has a paid sick leave referendum on the ballot for November that would allow employees to take leave for medical treatment, preventive care, or diagnosis for themselves, as well as to care for a close family member who is sick or who needs diagnosis or preventive care. Additionally, employees would be allowed to use the time to deal with domestic violence or sexual assault (for example, using accrued time to flee to safety.)  Employees at firms with 10 workers or less could accumulate up to 40 hours, whereas larger companies would have to provide up to 72 hours of paid sick leave.

The Institute for Women’s Policy Research published a study this month, which estimates that nearly half of Milwaukee workers will benefit from the ballot initiative if passed and that employer savings will greatly outweigh any costs.  In fact, employer savings would total $38 million annually, largely due to decreased turnover.  Additionally, workers would save $1 million a year in health care expenditures due to decreased flu contagion at work.  Philadelphia is looking at a similar bill.

No one likes coming into work sick or leaving an ill child at home, but too many working men and women fear that if they take time off they will lose their job or not be able to cover the monthly rent.  According to a 2007 Wall Street Journal poll, 80% of Americans favor having employers provide paid sick time to employees and 78% say that employers who fail to do so pay for it in other ways, such as reduced productivity. [This would perhaps be a better leading paragraph]

States and Localities Lead the Way:  Increasingly, states and localities are addressing the issue through a combination of bills and ballot initiatives.

  • In San Francisco, CA, the voters approved a paid sick days ballot initiative in 2006.
  • Washington, DC City Council earlier this year approved a paid sick leave law. 
  • The California Assembly has already passed AB 2716, a paid sick days bill that would ensure all workers in the state have access to paid sick days to deal with routine illnesses or to care for a sick child.

The following states have or are considering paid sick leave legislation: Alaska, California, Connecticut, Illinois, Maine, Massachusetts, Minnesota, North Carolina, Pennsylvania, Ohio, Rhode Island, Vermont, and West Virginia.  The National Partnership for Women and Families maps out what localities and states are working towards paid sick leave and where we have already won victories.

Currently the vast majority of American workers are shortchanging their health and productivity by working while ill, not to mention potentially impacting the health of others.  Paid sick leave allows all of us to focus on recovering so that we can be better providers and employees.  It’s a common-sense public health solution — one that values working families and one that’s long overdue.

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Reports Find Election Administration in Swing States Not Significantly Improved:  Lack of Uniformity and Coordination a Substantial Roadblock to Smooth Elections

Common Cause and The Century Foundation have released the new version of their joint biennial report on election administration in 10 swing states and the findings are not very encouraging: while voters' desire to participate is growing, states have only made fitful progress improving the voting process, and in many instances things have moved backward since the last federal election in 2006.  Examining the most recent election experiences of Florida, Georgia, Michigan, Missouri, Ohio, Pennsylvania, Wisconsin, Colorado, New Mexico, and Virginia the report details serious problems in every major aspect of the voting process, along with a handful of bright spots where individual states are moving important reforms.  And while the difficulties covered a wide range of issues, the report’s authors found that “many fundamental issues persist because of basic structural problems in our election administration system, some of which are caused by decentralization and a lack of accountability.”

FairVote points to similar problems in two reports on the uniformity of election administration in individual swing states. (Reports on Missouri and New Mexico are available now, others will follow.)  The organization’s surveys of county election officials find that even in instances where states have put election practices in statute, local implementation sometimes fails to conform.  The Century Foundation and Common Cause authors further conclude that while local control over elections allows for some experimentation and development of improved practices, the lack of coordination and oversight means that best practices are rarely disseminated to other localities and are therefore rarely practiced.

Among the most significant areas where inconsistencies undermine electoral administration and fairness are:

1. Voter ID implementation — Voter ID requirements are enforced in widely varying ways in the same state, resulting in discriminatory enforcement and de facto ID requirements more stringent than the law prescribes.

2. National Voter Registration Act (NVRA) Compliance — Many states have experienced problems complying with federal requirements that people be offered the opportunity to register to vote when they interact with certain government agencies.

3. Provisional Ballots — While provisional ballots are supposed to preserve a voter's ballot when voters' names aren’t found on the poll books, election officials often withhold these ballots incorrectly or force voters to cast them when they should be allowed to cast a regular ballot.

4. Voting Machine Allocation — The majority of states have no consistent policies, and in the two states FairVote surveyed, almost all municipalities have no written plan for allocating machines.

5. Poll Worker Training — The widespread lack of uniform poll worker training within states is a fundamental weakness in our voting systems that leads to a large number of problems on election day, including two listed above — voter ID implementation and provisional ballots. 

Voter Registration Problems Continue to Pose the Biggest Threat to Eligible Voters’ Ability to Cast a Ballot:  While a few gains have been made in the past two years, a host of problems continues to plague the voter registration process in many states.

  • Voter purges and rejected registrations continue to be carried out in states with poor voter list maintenance procedures.
  • Third party registration is under attack in several swing states where progressive organizations have registered substantial numbers of voters in recent years.
  • NVRA compliance continues to lag in many states, especially at public services agencies.  

The persistence of problems with voter registration practices suggests that they will remain a focus of election reformers.  The scope of these problems also indicates that comprehensive approaches to fixing our voter registration systems are required if we are to secure the franchise for every eligible voter.  Advocates and progressive lawmakers are increasingly aware of this need and efforts to secure universal voter registration are beginning to advance.

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Research Roundup

Nowhere to Turn: How the Individual Health Insurance Market Fails Women, is a new report from the National Women's Law Center, and comes at a crucial time as health care reform is focusing on reform to health insurance markets.  The report details how the individual market, with its exclusions and wait-periods for maternity coverage, gender-based rating discrimination, and other unfair and discriminatory practices, leaves women with higher premiums and out of pocket costs - if not denied coverage altogether for reasons unique to women - and puts their health and financial security at risk.

The Alliance for Public Technology (APT) and the Communications Workers of America (CWA)  released a report with a comprehensive, searchable database of state government initiatives for access to advanced communications. Entitled State Broadband Initiatives: A Summary of State Programs Designed to Stimulate Broadband Deployment and Adoption, the report surveys state initiatives in seven key areas: broadband commissions, task forces, and authorities; public-private partnerships; direct funding programs; state networks; telehealth initiatives; tax policies; and demand-side programs.

With national unemployment reaching a five-year high of 6.1% and many states experiencing rates as high as 8.9%, the Economic Policy Institute has released an Economic Snapshot featuring an interactive map showing the unemployment rate of each state in August, as well as the employment gains and losses incurred by each state since the economic downturn began in December 2007.

A proposed federal plan by Senators Wyden and Bennett would convert public programs like Medicaid and SCHIP into supplemental health insurance programs, while replacing most employer and individual insurance with new state-based insurance purchasing pools through which nearly all Americans would obtain private coverage.  While an analysis by the Center for Budget Policy & Priorities finds some positive aspects of the proposal, they also see dangers in whether it would end up mostly covering the sickest Americans and whether the replacements for Medicaid and SCHIP would have long-term viability for the poorest families.

In a new report, the Center for American Progress finds reviews the experiences of states extending benefits to same-sex domestic partners of state employees.  They have done so largely without complications or added expenses and many have actually been able to attract higher quality staff.

Last week, Rhode Island's Department of Revenue Division of Taxation released a report detailing the tax credits and incentives that nearly 120 companies operating in Rhode Island received over the past year.  The report is the result of Rhode Island recently passing some of the most comprehensive disclosure legislation intended to reveal to the public and policymakers how much money Rhode Island corporations receive-- a good model for states around the country to aim for in transparency.

The Alliance to Save Energy is producing energy efficiency policy briefs, entitled State Energy Efficiency Policies: Options and Lessons Learned, including Brief #1: Funding Mechanisms for Energy Efficiency on the four prime ways to fund such programs, along with Sample Legislation for State Energy Efficiency Policies that will expand as new policy briefs are published.

Long Distance Voter, supported by Rock the Vote, has created a comprehensive resource for registering to vote and voting by mail via absentee ballot. Their absentee voter guides include forms, deadlines, step-by-step directions, and a breakdown of all the relevant rules and ID requirements. 

A poll out this month by progressive think tank and advocacy organization NDN shows that voters in the key states of Florida, Colorado, Nevada, and New Mexico overwhelmingly support comprehensive immigration reform, including a path to citizenship for undocumented workers.  Roughly 60% of voters in those states believe that undocumented immigrants are taking jobs that nobody else wants to do versus taking jobs from citizens and authorized immigrants.

Please email us leads on good research at


Addressing the Shortage of Primary Care Physicians

American Medical Student Association (AMSA) - Student Debt Fact Sheet 2008
AMSA - Creative Debt Solutions
AMSA - Charting a Course to Medical School: The AMSA Map for Success - States Work to Avert Nurse Shortage

Paid Sick Days on Ballot in Milwaukee

Wall Street Journal/ Harris Interactive - Most U.S. Adults Support Paid Sick Leave
Institute for Women’s Policy Research — Valuing Good Health in Milwaukee: The Costs and Benefits of Paid Sick Days
San Francisco Paid Sick Leave
Progressive States Network - Stateside Dispatch: Paid Sick Days and Paid Leave Bills Approved in D.C.
CA AB 2716

Reports Find Election Administration in Swing States Not Significantly Improved:  Lack of Uniformity and Coordination a Substantial Roadblock to Smooth Elections

Common Cause and The Century Foundation — Voting in 2008: Ten Swing States
FairVote — Uniformity in Election Administration, Missouri Edition
FairVote — Uniformity in Election Administration, New Mexico Edition
Progressive States Network — Steps States Can Take to Register Voters and Keep Them Registered
Brennan Center for Justice — Universal Voter Registration: Policy Summary


The Stateside Dispatch is written and edited by:

Nathan Newman, Policy Director
Caroline Fan, Policy Specialist
Julie Schwartz, Policy Specialist
Christian Smith-Socaris, Policy Specialist
Adam Thompson, Policy Specialist
Austin Guest, Communications Specialist
Marisol Thomer, Outreach Coordinator

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