Long-Term Primary Care
As the shortage of Primary Care Physicians increases, the average age of civilian PCMs in DOD increases (and near retirement), and the number of doctors choosing to train as PCMs decrease, the DoD should look into securing providers to maintain the PCMH model. As the average PCM doctor requires over a quarter million dollars and 7 years (post-baccalaureate) to create, the DoD should look to mid-level providers to become the principle PC providers. Utilizing the current PA program at Fort Sam Houston, an expansion to allow civilians to commit to primary care training in exchaneg for a 6 year commitment, will allow a steady flow of PC providers beginning in 2 years. The program can be supplemented with a primary care track where the clinical time is spent learning PCMH supportive care know-how and de-emphasizing surgical rotations. These providers would then be used in clinics at a lower salary level (GS 11 vs GS 15 + LMS) and could afford better access as we change the ratio in PCM clinics from 6-7 doctors to 2-3 doctors and 4-6 midlevels (more appointments per day and less cost per appointment due to decreases civilian pay roll). Since the PA training program at Ft Sam already exists, it would only need a marginal investment to increase enrollment and allow the DoD to get a guaranteed supply of PCMs.