HealthDay News -- President Barack Obama's swearing-in this week marks what many in the medical community see as the best hope in years of garnering federal support for needed health-care reforms.

In small forums across the country last month, physicians, patient advocates and other community health leaders responded to a call from Tom Daschle, President Obama's nominee for Health and Human Services Secretary, for input on how to fix the nation's broken health-care system.

"The main thing is that there's an historic opportunity" said Dr. John W. Williams, professor of medicine at Duke University School of Medicine, who attended a gathering in Raleigh, N.C., last month with other physicians and other community health.

In interviews with physicians who led or participated in three of those forums, some common themes emerged. One was the need to expand not only access to care but the availability of primary-care services.

"This country, unlike other countries, is appallingly lacking in primary care, and unless we can create ways to attract more physicians and other health personnel to deal at the community level, we are not going to create better care pathways," said Dr. Kathleen (Kate) T. Grimm, president-elect of the medical staff of Great Lakes Health System of Western New York in Buffalo and a forum moderator.

In the short term, having universal coverage without strategies for expanding the pipeline of primary-care providers could exacerbate the problem, Raleigh participants noted. "All these people now have the means to see a physician, but there's no one for them to see," Williams explained.

At a Senate confirmation hearing earlier this month, Daschle emphasized the need to expand preventive care and to lure more medical students into primary care.

Community health leaders also called for an easing of financial, legal and regulatory barriers that hinder creative solutions to better health-care delivery. These restrictions made it difficult to coordinate care among various health-care "silos," they said. In Buffalo, for example, the stringent regulatory environment has made it difficult to address the needs of homebound seniors, Grimm said.

At a forum in Tacoma, Wash., health and human service leaders identified the "misuse, underuse and overuse of services" as a significant driver of costs and urged that the nation begin to spend its health-care dollars more wisely.

"We already ration based on ability to pay, employer and pre-existing health status. We need to ration based on reason and intelligence," said forum leader Dr. Ali M. Thomas, an internal medicine physician with Group Health Cooperative in Tacoma.

As an example, "Primary care systems like the medical home must get more money than robotic surgery or redundant procedures," Thomas said.

In Raleigh, participants agreed that the move to electronic medical records (EMRs) -- an Obama administration priority -- will improve the quality and coordination of care. But it could negatively impact primary-care practices because "everyone's experience has been that it slows you down, that you can see fewer patients," Williams explained.

The answer? "We either need to figure out ways to integrate them in our practices such that it doesn't slow us down, or we need reimbursement models that reward the higher quality that comes along with them, because we're going to be seeing fewer patients," he said.