September 18, 2009

Shortage of rural docs in the West threatens health care reform

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One hitch in the path to health care reform and its promise of health care for all is literal access to medical care. In the town of Walden, Colorado,  for example, the drive to see the doctor means a drive of 6o miles. In one Texas county, the shortage is so acute that a rancher with no medical training runs a mobile medical clinic out of a spotless 40-foot truck.

The Denver Post reports that are now 75 openings for physicians or physicians’ assistants in rural Colorado, compared to 62 openings two years ago, “which doesn’t speak very well for how we are keeping up,” said Dr. Mark Deutchman, who runs the “rural track” program at the University of Colorado Denver School of Medicine.

“Deutchman and others say reform should provide financial incentives, including more generous loan-forgiveness programs and scholarships, to entice medical students to choose rural jobs. Also, they argue, Medicare, Medicaid and private insurance companies should pay primary-care physicians more.

Rural doctors earn less than their urban and suburban counterparts, some making $50,000 to $80,000 per year, while the average medical school loan debt is $155,000. The number of American medical school students choosing primary care has slid 51.8 percent since 1997, according to the American Academy of Family Physicians. Legislation in Congress would increase Medicare reimbursement for rural physicians, who currently receive less reimbursement than urban doctors.

In  Texas,  lawmakers this year enhanced the state’s medical school loan repayment program to encourage doctors to practice in underserved areas, Corrie MacLaggan of the Austin American-Statesman reports. The changes increase the amount of money available to each doctor from $45,000 over five years to $160,000 over four years. Still, there are 27 Texas counties that have no doctor at all.

Tom Banning, CEO of the Texas Academy of Family Physicians, said that the number of primary-care doctors the state produces hasn’t kept pace with its birth rate and the influx of residents from other states. Nationally, there are 81 primary-care doctors for every 100,000 people; in Texas, the average is 68.

“There aren’t enough doctors currently practicing in Texas to care for the folks we have, much less the uninsured,” Banning said. Texas has the nation’s highest rate of uninsured – one in four.

— Rita Hibbard

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