Commentary: A need for leadership in primary health care for the underserved: a call to action

Health system reform and efforts to achieve universal health coverage are under way. Community health centers have become the centerpiece of the nation's efforts to provide access to primary care for all, and the Massachusetts experience in health care reform has reinforced the need for these safety-net providers. When access is expanded, community health centers experience a greater need for primary care providers, who already are in short supply. To address this need, medical education must become a core part of the community health center mission. Academic medical centers must facilitate this process, and government agencies must provide new regulatory and funding mechanisms. Universal access also requires skilled physician leadership for underserved settings. Leadership training has a direct impact on the ability of medical directors to make continual system improvements. New programs are needed to develop this workforce. To respond to the looming crisis in primary care staffing and leadership for community health centers, we propose as a blueprint a five-step call to action: (1) build horizontally and vertically integrated collaborations between academic medical centers and community health centers, (2) increase opportunities for trainees in underserved primary care settings, (3) offer leadership training for physicians committed to care for the underserved, (4) create a national program to provide longitudinal training and mentorship for potential primary care physician-leaders, and (5) identify new funding mechanisms for medical education in community health centers. This blueprint outlines a process for developing collaborations among academic medicine, community-based safety-net institutions, and government that are needed to achieve meaningful health system reform.