Showing posts with label doctor shortages. Show all posts
Showing posts with label doctor shortages. Show all posts

Thursday, October 16, 2014

The cure for doctor shortages in rural South Dakota is to find more in-state residency spots

South Dakota medical school graduates who practice their residency within the state usually end up staying in state to practice medicine. But a shortage of open residency spots is forcing graduates to leave the state for their residency, resulting in many of those doctors beginning their careers out of state, leaving rural South Dakota with a severe lack of doctors, Scott Feldman reports for the Rapid City Journal.

About 40 percent of people who get their medical degree in South Dakota remain in state to practice, but when they also have their residency in state, that number jumps to 77 percent, said Dr. Mary Milroy, president of he South Dakota State Medical Association, Feldman writes. The problem is that South Dakota currently has 225 medical students and only 134 residency spots. That means that about 40 percent of the state's medical students are forced to leave the state for their residency.

That's bad news in a mostly rural state where "25 percent of South Dakotans live in a place with a shortage of primary health care options, and many of those people are in rural West River areas," Feldman writes. Milroy said the best way to improve the retention rate is "to increase the availability and range of graduate-level residency opportunities in the state."

The problem "is that the number of federally funded graduate-residency spots has been capped," Feldman writes. "Three bills are now before Congress that would increase the number of federally funded graduate medical education positions by 15,000 over the next five years. If passed, these pieces of legislation would provide critical funding to aid in the expansion of South Dakota’s residency slots, Milroy said." (Read more)

Wednesday, September 03, 2014

Osteopathic care a rapidly growing profession, especially in small towns and at rural colleges

As more rural Americans gain access to health insurance under federal health reform, those with a brand new insurance card are seeking out doctors, only to find that many small towns are facing doctor shortages and existing doctors are overloaded with patients and unable to take on new ones. That could soon change for patients seeking osteopathic care, a profession that has steadily grown. Many osteopathic programs are popping up in rural areas, such as Pikeville University in Eastern Kentucky.

"Colleges of osteopathic medicine—there are now 42, including branch campuses—are seldom attached to teaching hospitals," Michael Ollove reports for Stateline. "Most send their students to community medical centers for training. The schools tend to be located in areas that are medically underserved, and they encourage their graduates to work in such areas. In the past, that has meant building osteopathic medical programs in rural areas, like Appalachia and the Great Plains. But recently, they have also located in underserved urban and suburban areas as well. (Stateline graphic)

"Osteopathic doctors are in every state, and colleges of osteopathic medicine have sprouted up in all regions, some in collaboration with public universities," Ollove writes. "According to the American Association of Colleges of Osteopathic Medicine, more than 20 percent of medical students now train in osteopathic medicine."

That wasn't always the case. The profession has grown from 13,022 osteopathic practitioners in the U.S. in 1970 to more than 82,000 today, compared to 790,000 medical doctors, Ollove writes. "Most Americans are probably unaware that two tracks of medical training exist, both of them producing fully licensed physicians. Although osteopathic medical graduates can and do go on to all the medical specialties when they become residents, osteopathic medical colleges discourage early specialization and emphasize general medicine."

Clif Knight, an M.D., and vice president for education at the American Academy of Family Physicians, "said that while some allopathic medical schools are strong in family medicine, others are not, perhaps to the point of not even having departments of family medicine," Ollove writes. Knight told him, “Osteopathic medicine has a much more consistent focus on primary care" and gives students early exposure to patients to emphasize the importance of forging strong relationships with them. (Read more)

Friday, August 29, 2014

Rural doctor shortages can be attributed to not enough rural residents applying to medical school

The main problem with doctor shortages in rural America is that not enough rural Americans are applying to medical school and most medical schools are located in cities far from rural life, Olga Khazan reports for The Atlantic. "There are about 6,000 federally designated areas with a shortage of primary care doctors in the U.S., and 4,000 with a shortage of dentists. Rural areas have about 68 primary care doctors per 100,000 people, compared with 84 in urban centers. Put another way, about a fifth of Americans live in rural areas, but barely a tenth of physicians practice there."

However, "The breakdown starts with medical education: There are too few applicants from rural areas applying to medical school," Howard Rabinowitz, professor of family medicine at Thomas Jefferson University's Medical College, told CNN. "And about half of the ones who do come from the countryside don't wish to return there after they graduate."

"Medical students with country roots are more likely to return . . . but some studies suggest rural students are less likely to go to college in the first place," Khazan writes. "Residents practice near where they train, but many of the nation's most prestigious medical schools are in big cities—and they are less likely to enroll rural students."

"After eight grueling years of school and with hundreds of thousands in student loan debt, many doctors are reluctant to give up a city's creature comforts for a more hardscrabble existence," Khazan writes. "A recent poll by Sermo, a social network for doctors, found that a lack of cultural opportunities topped the list of reasons it was hard to recruit rural physicians." (Read more (Centers for Disease Control and Prevention map: Primary care doctors per 100,000 people in 2012)

Tuesday, August 19, 2014

Wal-Mart opens primary-care clinics in Texas, South Carolina in bid to win over patients, boost sales

Rural areas are facing doctor shortages and hospital closures at a time when millions of previously uninsured Americans have gained coverage through federal health reform. With more people seeking care and fewer places to get it, there's a gap in rural areas for much-needed services. An unlikely source is making a bid to add rural health care to its resume. The biggest retailer in the U.S. has entered the medical field. Yes, Wal-Mart is bidding to be your primary health-care provider.

Wal-Mart "has opened six primary care locations in South Carolina and Texas and has plans to open another six by the end of the year," Laura Lorenzetti reports for Fortune. "Unlike existing urgent care centers at CVS or Walgreens stores, the Wal-Mart clinics are billing themselves as primary medical providers." (NYT photo by Rex Curry: Wal-Mart clinic in Carrollton, Tex.)

"Walmart’s clinics are partnering with QuadMed to staff their offices with nurse practitioners and physician assistants, who are fully qualified to diagnose illnesses and write prescriptions, but don’t have the full training of a medical doctor," Lorenzetti writes. "Each location will have a supervisory physician, although they will not actually treat patients." And costs will be cheap. "Patients are charged $40 a visit, while employees and dependents who are covered under Walmart’s insurance pay $4 a visit. The clinics accept Medicare and are starting to enroll some locations in Medicaid, but do not yet accept third-party insurance."

About 15 to 20 patients use the primary clinics in South Carolina and Texas every day, but a large percentage of them don't have another primary doctor, according to Dr. David Severance, the corporate medical director at QuadMed, Rachel Abrams reports for The New York Times. "For patients with complex issues, Dr. Severance said, the goal was for Walmart to be a patient’s first stop and part of a continuum of care."

"Walmart’s same-store sales, or sales at stores that have typically been open for more than 12 months, have been on the decline in recent months, and 10 percent of sales have evaporated at big retailers as more consumers shop online, according to Matt Nemer, a retail analyst with Wells Fargo," Abrams writes. But getting people in the store can help drive up sales, especially at the pharmacy, which does accept insurance. (Read more)

Tuesday, August 12, 2014

Pilot program in Bhutan could foreshadow future of using drones to improve rural medical care

Could drones be used to improve rural health care? Matternet, "a Silicon Valley startup, is piloting a low-cost,  drone-based delivery project in the remote Himalayan nation of Bhutan that could save lives in far-flung rural communities—and perhaps pioneer the system globally," Devjyot Ghoshal and Daniel A. Medina report for Quartz, part of Atlantic Media. (Matternet photo: a drone in Bhutan)

Bhutan, which has only 3 physicians for every 10,000 people, has 31 hospitals. Its 178 basic clinics and 654 outreach clinics serve a population of more than 700,000, Ghoshal and Medina write. "The challenge is to reach remote mountain communities on time and affordably. ... If pilot projects such as these work out, they could potentially lead to a massive new market for drone-based applications."

Phil Finnegan, an analyst at the Teal Group, a U.S.-based firm that analyzes the aerospace industry, told Quartz, “Essentially, we see a market of civil government and commercial in terms $5.4 billion over the next decade. It’s quite promising, in a lot of areas, not only in humanitarian areas but also in things like agriculture.” (Read more)

If the program works, drones could be used in the U.S. to "deliver needed prescriptions to consumers in rural areas," Katie Williams reports for Healthcare Dive. "And theoretically, home and remote care through drone use could benefit from the increased push for regulations easing the path for telemedicine."

Wednesday, August 06, 2014

Federal report says changes need to be made to improve rural healthcare system

Rural areas only have 54 specialists for every 100,000 residents, while urban areas have 134 specialists for every 100,000 residents, according to a federal report that says changes need to be made to improve rural healthcare. The report by the Joint Economic Committee, authored by Sen. Amy Klobuchar (D-Minn.), says: "Improving rural Americans’ access to affordable health care would improve their quality of life and bolster economic opportunity in rural areas."

More than 40 percent of rural residents travel more than 30 minutes to a hospital, compared to 25 percent of urban ones, and rural residents have to make longer treks to see a specialist, the report says. EMS response times are also longer in rural areas, with limited services often staffed by volunteers. Rural areas are also more reliant than urban areas on jobs from medical facilities. Technology is another concern. Only 19 percent of rural hospitals have adapted electronic health record systems, compared to 29 percent in urban areas. Rural hospitals are also more likely to rely on Medicaid and Medicare for revenue.

"Ensuring access to health care in rural areas can help improve workforce productivity, quality of life and economic growth," the report says. Suggested ways to improve rural healthcare are by protecting critical access hospitals, funding programs that attract doctors to rural areas, enhancing training for rural health care practitioners in preventive services, expanding Telehealth Resource Centers and the Telehealth Network Grant Program and improving transportation infrastructure. (Read more)

Friday, August 01, 2014

South Dakota trying to recruit doctors to rural areas; med school begins rural residency program

South Dakota is trying to find ways to recruit doctors to rural areas with programs aimed at sparking interest among students in middle school, high school and college into pursuing physician jobs in the state's medically under-served areas.

One problem facing hospital recruiters in states like South Dakota, Minnesota, Iowa, Nebraska and North Dakota is the extreme winters, Dr. Tad Jacobs, chief medical officer for Avera Medical Group, told Joise Flatgard of the Capital Journal in Pierre. But those fears can be offset by a high quality of life, said Angie Bollweg, director of a Sanford Health clinic in the state capital of 14,000 people. She told Flatgard, “We do try to emphasize the different opportunities available in Pierre, everything that Pierre/Ft. Pierre has to offer. There are great schools, churches, great healthcare and an array of activities and groups to be involved in. The hunting, fishing, recreational activities and sunsets are a plus. It’s a wonderful place to raise a family and work and grow here, too.”

Sanford Health has been working to attract youth to the medical field through the Program for the Midwest Initiative in Science Exploration, Flatgard writes. Also known as PROMISE, it "was created to inspire middle school, high school and college students, along with anyone else interested to learn about science and research. In a classroom, educators and scientists are able to lay the groundwork for educating South Dakota physicians." (Read more)

While smaller towns are trying to interest local youth in entering the medical field, the University of South Dakota has created the Frontier And Rural Medicine program, which "puts third-year medical students into hospital systems in communities with less than 10,000 residents," Katherine Grandstrand reports for the Aberdeen News. FARM Director Dr. Susan Anderson told Grandstrand, "Hopefully, what's going to happen long-term is that the students are going to consider, when they're done with all their training, coming back to one of those communities or a similar-sized community in rural South Dakota to practice. Students tend to practice in or close to where they trained." The first class to participate in the program consists of six students working at five rural hospitals. (Read more)

Thursday, July 24, 2014

Missouri working to increase number of rural doctors; North Carolina gets grant to train rural nurses

Attempting to combat a shortage of health personnel in rural areas, Missouri and North Carolina are trying to fill the void through a program in one state to encourage more young doctors to choose to practice in rural areas and a program in the other state to advance the education of the state's nurses.

In Missouri, 37 percent of the state's residents live in rural areas, but only 18 percent of doctors practice in those areas, Grant Sloan reports for OzarksFirst. The University of Missouri is trying to help solve the problem through its Rural Summer Community Program that places medical students in rural areas. About 300 students have participated, or are currently enrolled, in the program, and about 50 percent of the students who participate in the program end up practicing in rural areas, "nearly 40 percent above the national average." (Read more)

Missouri lawmakers recently passed a bill allowing medical school graduates to bypass their residency to practice as an assistant physician—allowing them to treat patients and prescribe some medications—in underserved rural areas after spending 30 days working under the supervision of a a doctor. Gov. Jay Nixon's signed the bill into law earlier this month.

While Missouri is trying to increase its number of doctors, Western Carolina University received a grant for more than $1 million to train rural nurses to work in Western North Carolina. As part of the program, the state Department of Health and Human Services "will provide $350,000 annually over three years to create a program designed to increase the number of nurses with four-year degrees working in the mountains," Clarke Morrison reports for the Times-Citizen in Asheville.

"The project will support the development of nurses qualified as 'advanced rural generalists,'” Morrison writes. "It will focus on registered nurses with two-year degrees who are ethnic minorities or from economically and educationally disadvantaged backgrounds who work at Mission Hospital or one of the system’s rural affiliate hospitals in the region. The programs provides scholarships, stipends and mentorship opportunities to help students obtain bachelor’s degrees."

Judy Neubrander, director of the WCU School of Nursing, said "research has found that medical services are more successful when providers reflect the communities they serve," Morrison writes. "Although the majority of nurses who work in rural health care facilities grew up in rural communities, many lack the advanced levels of education and training needed today, Neubrander said." (Read more)

Wednesday, July 16, 2014

Montana program hopes to inspire rural teens to enter medical field, practice in rural areas

Rural areas have tried dozens of ideas to draw much-needed doctors to underserved areas, including incentives such as tax breaks, and college programs that require medical students to spend time at rural facilities in an attempt to encourage them to consider practicing in those areas. But a Montana program is taking its message to high-school students, hoping to inspire students to enter the medical field and practice in the state.

Ten Montana countiss lack any practicing physicians, and almost every county has been designated by the federal government as a primary-care physician shortage area, Derek Brouwer reports for the Billings Gazette. Enter the MedStart Summer Camp. Funded by the Montana Area Health Education Center, the camp "aims to put the wide world of health care within reach of these promising high school juniors and seniors. It’s one way AHEC hopes to encourage young Montanans to study and practice medicine, a field in high demand in the state’s rural areas, AHEC Eastern region director Mary Helgeson said." (Gazette photo by Larry Mayer: Students at the camp)

During the recent weeklong camp in Billings, the 27 participants measured vital signs at City College Billings, shadowed professionals at area hospitals, obtained X-rays of their cellphones and took part in a mock search-and-rescue operation in Red Lodge,  Brouwer writes. "On Tuesday they were at RiverStone Health to learn about the services provided by Yellowstone County’s public health department." Helgeson told Brouwer, “We want to get them excited so they’ll get their education and go back to their communities." (Read more)

Thursday, July 10, 2014

Rural Kansas hospital says it has good strategy for recruiting doctors; Michigan ups incentives

While many rural areas have struggled with doctor shortages, medical professionals in Lakin, Kan., say they have uncovered the key to recruitment success, Mike Shields reports for the Kansas Health Institute. "In Kearny County, on the High Plains near the Kansas-Colorado boundary where there are only about five residents per square mile, one small hospital has adopted a distinctive approach to recruitment that in a relatively short time has produced a staff that includes five doctors, five physician assistants and a growing volume of patients."

The key, Kearny County Hospital CEO Benjamin Anderson told Shields, is to direct searches at four specific types of doctors: someone born and raised in the area looking to return home; foreign doctors who gained U.S. resident status by agreeing to work (usually temporarily) in an under-served area; a "challenged doctor" with addictions or other problems who struggles with accountability issues; and a missionary-type person, someone "driven by by mission or purpose” to treat those in need.

Anderson told Shields that doctors they recruit “aren’t that interested in country clubs, not that interested in ego and money and prestige and elite social clubs. What they are there for is to serve. That doesn’t mean our community is Third World, and it doesn’t mean it is inferior. There is need everywhere.” The hospital also offers four-day work weeks, limited emergency-room calls and eight weeks off each year to pursue other interests or missionary work. (Read more)

While that method has worked in Kansas, Michigan is trying to draw new doctors the old fashioned way—through incentives. Gov. Rick Snyder signed a bill this week that hopes to bring more doctors to under-served areas by increasing "the maximum annual repayment benefit for a doctor from $25,000 to $40,000, which "creates a lifetime cap of $200,000," reports the Midland Daily News. It also allows the state Department of Community Health "to give preference to physicians studying general practice, family practice, obstetrics, pediatrics or internal medicine." (Read more)

Wednesday, June 25, 2014

Bill would allow Missouri medical school grads to bypass residency to practice in rural areas

Missouri's rural doctor shortage could soon come to an end. The state legislation passed a measure adding the classification “assistant physician” to the state medical license. The new classification, if signed into law by Gov. Jay Nixon, would allow medical school graduates who have passed licensing exams to bypass their three-year residency and practice primary care and prescribe drugs in rural and underserved areas, Blythe Bernhard reports for the St. Louis Post-Dispatch. "Their practice would be overseen by a physician who would be required to be on-site only for the first month."

About 37 percent of state residents live in rural areas, but only 18 percent of primary care doctors practice in those areas, Bernhard writes. "Jeffrey Howell of the Missouri State Medical Association said the number of potential new doctors in Missouri could be much higher when graduates of foreign medical schools are included. As the only state in the country with the assistant physician designation, Missouri could attract medical school graduates looking to start practicing medicine, he said."

But not everyone supports the idea. Rosemary Gibson, a board member of the Accreditation Council for Graduate Medical Education, told Bernhard, “I question whether four years of medical school is enough to go out and take care of patients. People in rural and under-served areas deserve a fully trained, competent physician just like everyone else.”

Dr. Kathryn Diemer, assistant dean for career counseling at Washington University in St. Louis "is concerned about the amount of education the assistant physicians would receive when practicing in rural areas," saying the first year of residency is a critical learning opportunity, Bernard writes. Diemer told Bernard, "That was a year that I learned so much about decision-making and learning how to trust my judgment. I’m not sure medical students after two years of clinical experience could be ready to be that independent.” (Read more)

Tuesday, June 17, 2014

Physicians at national meeting discuss future of rural primary care, how to solve doctor shortages

The shortage of primary-care physicians is a big problem in rural areas, and people need to do more to meet the need, according to a panel of physicians at "Rural Health Journalism 2014," Kris Hickman writes for the Association of Health Care Journalists, sponsor of the conference last weekend in Portland, Ore.

Almost half of rural counties, 44 percent, struggle with primary-care physician shortages, said Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care of the American Academy of Family Physicians. He said the U.S. ranks lowest in primary care and health outcomes among 10 other highly developed nations.
Primary care docs per 100,000 in 2012 (Centers for Disease Control and Prevention)
The number of primary-care doctors is expected to drop soon because almost 27 percent of those providers are older than 60, said Mark A. Richardson, M.D., dean of Oregon Health and Science's School of Medicine.

Bazemore said the medical community needs to draw more attention to the need for more primary care physicians in rural areas. He also said that for every dollar spent on health care, only six or seven cents are spent on primary care. "States facing a shortage should remember that primary care is the logical basis of any health care system," Bazemore said.

Richardson recommended that medical schools try to recruit students who have rural backgrounds because they're more likely to return to practice in rural areas. He and Bazemore agree that students who practice in rural areas should be given loan forgiveness or scholarships. "Debt prevents many people from choosing primary care," Bazemore said.

Richardson said the most important factor for where medical students end up practicing is where they completed their training. "Rural training is one of the highest predictors of a rural practice and should be required," he said. To do this, the government-imposed cap on graduate medical education (GME) spending would have to be abolished.

Bazemore said primary care in rural America "should be affordable and accessible to all. It should be more patient-centered and community-oriented . . . rather than the current fee-for-service dynamic that is 'provider and hospital centric,'" Hickman writes.

"Medical care is not a free market dynamic," Richardson said. "We pay for health care transactions, rather than health." (Read more)

Monday, June 09, 2014

Doctors in ERs say they're busier since Obamacare began; hospitals struggle to handle extra patients

Nearly half of emergency-room doctors say their ERs have seen an increase in patients since health reform went into effect, and 86 percent say they expect the increase to continue, according to a poll by the American College of Emergency Physicians. Of the 1,845 completed surveys, 9 percent said ER visits had increased greatly and 37 percent said they had increased slightly. When asked what they think will happen over the next three years, 41 percent said visits will increase greatly and 45 percent said they will increase slightly. (ACEP graphic)

"Dr. Jay Kaplan, a member of ACEP's board of directors, said he wasn't surprised by the findings given the large influx or Medicaid enrollees and the difficulty in locating primary-care doctors who will see those patients," Paul Demko reports for Modern Healthcare. Kaplan told him, “When people get insurance, they feel like they deserve healthcare. When they deserve health care, and there's nobody else they can see, they come to us.”

77 percent of respondents
said their ER is not prepared
for an increase in patients
But some hospitals say many patients are going to the ER for ailments that are not emergencies, Laura Ungar reports for The Courier-Journal. Lewis Perkins, vice president of patient care and chief nursing officer at Louisville's Norton Hospital, said the emergency room is seeing 100 more patients per month, an increase of 12 percent. "We're seeing patients who probably should be seen at our (immediate-care centers)," he told Ungar. "And we're seeing this across the system."

ER visits at the University of Louisville Hospital are up 18 percent, while Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physicians' group, said ER services are up 7.5 percent in that city. He told Ungar, "It's a perfect storm here. We've given people an ATM card in a town with no ATMs." (Read more)

Phil Galewitz of Kaiser Health News reports that a study in Massachusetts following its Obamacare-like expansion showed an initial surge in ER use followed by a decline over several years. Hospital officials around the country told him that the biggest impact of the expansion of Medicaid is that patients can now go to a primary-care doctor instead of the emergency room for routine care.

Tuesday, June 03, 2014

Rural Kansas hospitals use specialized robots, at $50,000 apiece, to deal with doctor shortages

Some rural hospitals in Kansas have found a way to make up for a shortage of doctors bu using robots tho assist with various procedures "including emergency room stroke treatment, dermatology and specialty pediatrics," Mike Shields reports for the Kansas Health Institute. The robots can also connect "distant doctors with patients and local medical providers in real time via a high-definition mobile visual display that includes various monitoring and imaging attachments such as a digital stethoscope." (Hamilton County Hospital photo)

Robots have been a lifesaver for businesses such as Syracuse-based Hamilton County Hospital, which in June 2013 lacked a single doctor and was on the brink of closing, Shields writes. Since adding a robot the hospital has seen a 40 percent growth in patients.

The University of Kansas Hospital is also working with facilities to help stroke doctors connect with patients via the robots, Shields writes. KU spokesman Tony Nunn said "doctors will be available around the clock for remote consultations" and will be able to link to the robot using an iPad or computer. Nunn told Shields, “It’s like ‘The Jetsons’ on steroids."

The robots are created by California-based InTouch Health, which states it serves more than 1,000 hospitals worldwide. Twenty Kansas facilities currently use robots, and 10 more expected to begin using them by next month, Shields writes. But the cost is steep—around $50,000 per robot. Hamilton County chief executive Bryan Coffey has been so impressed by his robot that he wrote an article offering suggestions about how small hospitals can find the funds to afford robots. (Read more)

Thursday, May 22, 2014

New anti-abortion laws in South, most recently in La., increase difficulties for women in rural areas

"The Louisiana State Legislature on Wednesday passed a bill that could force three of the state’s five abortion clinics to close, echoing rules passed in Alabama, Mississippi and Texas and raising the possibility of drastically reduced access to abortion across a broad stretch of the South," Jeremy Alford and Erik Eckholm report for The New York Times. "The new rules passed by Republican legislatures require that doctors performing abortions must have admitting privileges at nearby hospitals, a provision likely to shut down many abortion clinics across the region."

Like those in some of the other states, most rural hospitals in Louisiana don't have doctors who perform abortions and rely on those services to be performed by "visiting doctors who are ineligible for admitting privileges at nearby hospitals because they do not admit enough patients or for other reasons unrelated to medical skills," the reporters write. Passage of the bill forces many rural patients seeking abortions to drive hundreds of miles away, sometimes to another state. But as anti-abortion laws continue to sweep the South, driving distances keep increasing.

"In addition, some religiously affiliated and other hospitals refuse formal associations with abortion clinics," the Times reports. "But these hospitals still accept emergency patients and have specialists who treat women suffering abortion complications, medical experts say." (Read more)

Wednesday, May 07, 2014

Rural Idahoans lack access to mental health care; expanding Medicaid would have helped

Like many mostly rural states, Idaho suffers from a shortage of doctors. But Idaho's rural residents have limited, or in many cases, no access to mental health professionals, Daniel Walters reports for Boise Weekly. About 33 percent of Idaho residents live in the country, and 25 percent of the state's residents lack access to a psychologist or psychiatrist, meaning residents are forced to hit the road, sometimes driving five hours from home, to get treatment. Others receive treatment from doctors in Boise through telepsychiatry services. (Weekly photo: Dr. William Terry, left, and Dr. William Hazle meet with rural patients via a computer)

Idaho ranks last in the number of psychiatrists per person, according to 2012 Kaiser Family Foundation data, and is also last in mental health funding, Walters writes. "The state is rural and underfunded with a high incidence of mental illness. Despite its sky-high suicide rates, it was the last state in the nation to get a suicide hot line."

Of the 1.5 million Idaho residents, 72,000 suffer from mental illness, including 18,000 children, according to a 2010 report from the National Alliance on Mental Illness. In 2006 the state spent just $46 per capita on mental health agency services, which amounted to only 1.3 percent of state spending that year.

In 2006 the state allotted 59 percent of state mental health spending to community mental health services, well below the national average of 70 percent. The state also spent 33 percent on state hospital care, higher than the national average of 28 percent. The state's public mental health system only provided care to 16 percent of adults who suffer from serious mental illness. (Read more)

Financial problems stem from the recession and from the Republican-led state's decision not to expand Medicaid under federal health reform, Walters writes. From 2008 to 2012 the impact of the recession led state mental health care funding to decrease by more than 28 percent, while federal funding dropped by nearly 50 percent. Meanwhile, if Idaho has expanded Medicaid, the state would have saved more than $400 million across 10 years, according to a report from the Idaho Workgroup.

"Idaho's Health and Welfare department is intended to fill a gap, providing mental health care for those without access to insurance or Medicaid," Walters writes. "To balance the budget, Idaho eliminated redundancy. In the summer of 2010, 451 mentally ill Idahoans were kicked off state coverage and onto Medicaid or private insurance." (Read more)

Monday, May 05, 2014

Rural physicians make more than their urban counterparts, and have a lower cost of living

A lack of physicians in rural areas means those doctors often take on more patients, but they also earn more than their urban counterparts, according to the Medscape Physician Compensation Report. "Less competition among physicians in smaller communities and rural areas is a factor in boosting that region's income," Mark Crane writes for Medscape. "Smaller communities have to pay more to attract physicians. Also, with fewer specialists in rural areas, primary care physicians often perform more services than in the rest of the country." (Medscape map)
The report was created from a February 2012 survey of 24,216 physicians in 25 specialty areas. The highest salaries are in the North Central region ( Missouri, Kansas, Nebraska, South Dakota and North Dakota) where physicians average $234,000 a year. The lowest average earners are in the Northeast, where doctors in New York, Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island average $204,000. Despite the high salaries, only 54 percent of doctors say they would chose medicine again as a career, down from 69 percent the previous report, Crane writes. (Read more)

In the Southeast—Florida, Louisiana, Alabama, Georgia, Mississippi, Tennessee and Kentucky—the average salary is $226,000. Baptist Health Vice President Julia Henig, who helps recruit physicians to Montgomery, Ala., said rural and smaller town in-demand specialists make more because they have crowded schedules and are required to work long hours, Brad Harper reports for the Montgomery Advertiser. Henig told him, "Our physicians work harder. If you were to look at a per-patient basis, the compensation is actually not as high."

But cost of living, something not accounted for in comparing salaries, is a major draw in many rural areas, Harper writes. Henig told Harper, "When you drive physicians around the community and show them nice neighborhoods, they're shocked by the (low) price of homes. We have a lot of amenities." (Read more)

Tuesday, April 08, 2014

Loan forgiveness helps keep doctors in rural Oregon

Like many states, Oregon is trying to fill its need for more rural doctors. Help could soon be on the way. The College of Osteopathic Medicine of the Pacific Northwest recently became eligible to participate in a loan forgiveness program that provides as much as $35,000 per school year to recipients who "promise to practice in a rural Oregon community for each year they receive the loan," reports the Albany Democrat-Herald. "Ten percent of their clinical rotations must be in rural regions."

The Primary Health Care Loan Forgiveness Program, through the Oregon Office of Rural Health, is open to all students in the classes of 2016 and 2017, the Democrat-Herald writes. The osteopathic college had 105 new students this school year.

Eligible students are ones who "intend to go into primary care residencies, including family medicine, internal medicine, pediatrics and general surgery," the Democrat-Herald reports. "The curriculum includes on-campus and online teaching sessions, participation in the Family Medicine Rural Health Club and a community project." (Read more)

Tuesday, April 01, 2014

Primary-care doctors burn out; patients stressed too

"Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital," Roni Caryn Rabin writes for Kaiser Health News in The Washington Post. "The stress took a toll, though: He retired six years ago, at 62." There are thousands like him, and that is worsening America's shortage of primary-care physicians, which is particularly acute in some rural areas.

Though physician stress has always been a concern, recent reports and studies show an increase in discontent, particularly among primary-care doctors, Rabin writes: "Tired of working longer and harder because of discounted insurance payments and frustrated by stagnating pay and increasing oversight, many [doctors] are going to work for large groups or hospitals, curtailing their practices or in some cases, abandoning primary care or retiring early, experts say."

"The lack of an adequate primary-care infrastructure in the U.S. is a huge obstacle to creating a high-forming health-care system," said David Blumenthal, president of the Commonwealth Fund, a health-care research foundation. According to a 2012 Urban Institute study of 500 primary-care doctors, 30 percent of those 35 to 49 years old—and 52 percent of those over 50—planned to leave their practices in the next five years.

The doctors are stressed, and the patients are, too; some feel that their physicians don't have enough time to spend on each appointment and even worry about an increase in mistakes. In a 2012 Mayo Clinic survey of more than 7,200 doctors, almost half of those surveyed said they had at least one symptom of burnout. "What drives physician satisfaction is also what patients and payers want: delivering good care. And we're less and less able to do that," said Christine Sinsky, an internist in Dubuque, Iowa. "You spend less time listening to patients, getting to know them and thinking more deeply about their care."

American Board of Internal Medicine President Richard J. Baron wanted to record how much time a doctor spends caring for patients and found out "that on a typical day, he or she handles 18.5 phone calls, reads 16.8 emails, processes a dozen prescription refills (not counting those written during a visit), interprets 19.5 lab reports, reviews 11 imaging reports and reads and follows up on 13.9 reports from specialists," Rabin writes.

A related problem is the new policy about electronic medical records, which many greatly dislike, according to physician Mark Friedberg, a co-author of last year's RAND study. Instead of saving time, many doctors say the new system causes more problems and leaves "little room for the kind of personal, nuanced observation that was captured in an old-fashioned doctor's note," Rabin writes. "Many physicians said to us, 'I used to be a doctor; now I'm a clerk,'" said Jay Crosson, a pediatrician and vice president of professional satisfaction for the AMA. (Read more)

Wednesday, March 12, 2014

Cancer forecast to be No. 1 U.S. killer in 16 years, but rural areas severely lacking in oncologists

Cancer is predicted to be the No. 1 killer in the U.S. in 16 years, but rural communities have extremely limited access to cancer care, with only one of every 33 oncologists practicing in rural areas, according to a study from the American Society of Clinical Oncology, published in the Journal of Oncology Practice. Wyoming has the lowest presence of oncologists, with only 1.6 for every 100,000 people. Massachusetts has the highest, at 8.2 per 100,000. (ASCO graphic) 

By 2025 demand for cancer care is expected to rise by 42 percent, but the number of oncologists is only expected to increase during that time by 28 percent, leaving the country short about 1,500 cancer doctors, the study found. Rural areas have the most need for care, with small and mid-sized practices (six or fewer physicians) mostly in the South and West, serving one-third of new patients, but two-thirds of small community practices may merge, sell or close during the next year. (Read more)

For the study, the Community Oncology Alliance "followed 1338 clinics and oncology practices for six years," Roxanne Nelson reports for Medscape. Researchers found that 43 of these practices had begun sending patients elsewhere for treatment, 288 clinics had closed and 407 practices were struggling financially. More than 70 percent of the counties analyzed had no medical oncologists at all. (Read more)