Tuesday, 18 June 2013

U.S. Physician Shortage to Impact Rural, Poor Urban Areas

Written by 

Despite already widespread shortages of U.S. primary care doctors, less than 25 percent of new physicians are entering the primary care field, while a small fraction, only 4.8 percent, of new doctors are practicing in rural areas. These findings come from a study by researchers at the George Washington University School of Public Health and Health Services (SPHHS), and were in a report published in the “Ahead-of-Print” section in Academic Medicine.

The report suggests that the country’s availability of primary care doctors will continue to wane, furthering the damage to rural and struggling urban areas where medical care has already become sparse. “If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse,” asserted Candice Chen, MD, MPH, lead author of the study and an Assistant Research Professor of Health Policy at SPHHS. “The study’s findings raise questions about whether federally funded graduate medical education institutions are meeting the nation’s need for more primary care physicians.”

From 2006 to 2008, Chen and her colleagues analyzed the career paths of 8,977 doctors who had graduated from 759 residency locations, hoping to find where the physicians practiced three to five years after graduation. Overall, a mere 25 percent of the doctors worked as primary care physicians, although this figure includes graduates who work in hospitals, and not those who have developed their own practices.

Further, the study found that 198 out of 759 residency sites produced not a single rural physician from this three-year period, while another 283 institutions produced no physicians practicing in healthcare clinics that offer care generally to low-income patients — often found in poor or remote urban areas. “About 66 million people in the United States live in rural areas or urban neighborhoods that have too few primary care physicians or access to primary care in clinics,” said Chen. “That’s about one in five Americans who lack adequate access to this kind of essential care and might develop more serious health conditions as a result.”

Chen also noted that these “abysmally low” figures will generate an even greater shortfall of physicians as healthcare reform measures boost demand for medical services. Rural and urban clinics in impoverished areas already labor to acquire and retain primary care doctors.

A SPHHS press release on the study offered its own insight on the physician shortage:

The graduate medical education system (GME) in the United States relies on public funding including nearly $10 billion in funds from the Medicare program and another $3 billion from Medicaid. Despite the large infusion of cash, experts have said that the federal government does not hold residency programs accountable for producing physicians trained to serve in rural or underserved parts of the country. Even though Medicare and Medicaid represent the largest public investment in the U.S. health workforce, there are still serious shortfalls in the number of primary care physicians in some geographical regions and in other high need specialties like general surgery.

While the SPHHS opines on the impotency of government-funded physician programs, it neglects to address the broad impact of ObamaCare, which has already ignited doctor shortages throughout the nation. With the healthcare law comes an influx of new patients, along with government regulations that will only inflate the rising costs of healthcare.

The Doctors Company, the largest physician-run medical malpractice insurer, conducted a survey in which some 5,000 doctors offered their assessment on the future of healthcare reform. Sixty percent of respondents asserted that increasing patient volumes will negatively impact the quality of care they can offer. About half of respondents indicated that the ability to develop and maintain patient relationships will be more difficult. And most startlingly, a whopping 90 percent are so cynical about the future of American healthcare that they actively discourage friends and family members from considering careers in the medical field.

Since 2008, when the SPHHS concluded its study, physician shortages have only worsened, a problem many healthcare experts attribute directly to ObamaCare. The New York Times previously reported that an economically depressed region in Southern California, the Inland Empire, is expecting widespread shortages, as the law will be extending health coverage in the area to over 300,000 people by 2014:

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts acknowledge that there is no immediate fix for the problem, and there is virtually nothing the government or healthcare industry can do to fill the physician gap by 2014, when the law begins providing coverage to some 30 million uninsured Americans. “We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” asserted Dr. Richard Olds, the dean of a recently-formed medical institution at the University of California, Riverside, established partly to address southern California’s looming doctor shortages. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”