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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)

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