Ordering Up More Primary Care?

An executive order to rebuild primary care? That’s what the American College of Physicians (ACP) is proposing as a potential salve for the wounded primary care workforce, which has seen its ranks continually devastated by the migration to subspecialties and payment policies that have favored those specialists over the generalists.

Image via Flickr user austinevan by Creative Commons License

The ACP issued the call in a report released February 17 (see p. 12, here). “We urge President Obama to issue an Executive Order on Increasing Primary Care Workforce Capacity,” said the society, which represents internal medicine doctors. Apparently, the organization made a similar call one year ago, but to its chagrin, the White House has not yet directed all federal agencies to “to develop and implement policies to increase primary care workforce capacity in the United States….”

So, what exactly is an Executive Order? According to ThisNation.com, “Executive Orders do not require Congressional approval to take effect but they have the same legal weight as laws passed by Congress.”

The orders are often the equivalent of a presidential sledgehammer, having been used (again, according to ThisNation.com) by Harry Truman to integrate the U.S. military, Dwight D. Eisenhower to desegregate schools, and Ronald Reagan to prohibit the use of federal funds for advocating abortion.  But they also run the gamut from proclamations to little-noticed advisories to federal agencies.

How often are Executive Orders used? The National Archives has been keeping records of orders since Franklin Roosevelt’s Administration (although they have existed since the nation’s first president).  FDR issued almost 3,500 orders in 12 years. Over his two terms, the less-government advocate President Reagan issued 380 orders. Surprisingly, William J. Clinton issued only 363 orders in his eight years as President. George W. Bush signed only 290 Executive Orders.

In his first year in office, President Obama has issued 41 orders. Those have ranged from the establishment of various councils and advisory bodies to ordering military reservists to assist with Haitian earthquake relief to taking down barriers to stem cell research.

Should rebuilding primary care rate an Executive Order from the President?

— Alicia Ault (on Twitter @aliciaault)

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Filed under Family Medicine, Health Policy, Internal Medicine, Practice Trends

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