Many places in America are essentially devoid of doctors
Via Kevin MD Dr. Kenneth Lin writes another article on disappearing rural medical care. this is part of the article…
I recently attended a conference in Savannah, Georgia sponsored by the Association for Prevention Teaching and Research.
Since I haven’t spent much time in Georgia outside of Savannah and Atlanta, the welcoming plenary on improving health outcomes for the state’s rural and underserved populations was eye-opening. According to Dr. Keisha Callins, Chair of the Department of Community Medicine at Mercer University, Georgia ranked 39th out of 50 states in primary care physician supply in 2013 and is projected to be last by 2020. 90 percent of Georgia’s counties are medically underserved. Mercer supports several pipeline programs that actively recruit students from rural areas, expose all students early to rural practice and community health, and provide financial incentives for graduates who choose to work in underserved areas of the state. But it’s an uphill battle. Even replicated in many medical schools across the country, these kinds of programs likely won’t attract enough doctors to rural areas where they are most needed.
When people talk about places where doctors won’t go, they tend to focus on international destinations, such as war zones in Syria or sparsely populated areas of sub-Saharan Africa. It’s hard to believe that many places in America are essentially devoid of doctors, and access to medical care is as limited as in countries where average income is a tiny fraction of that in the U.S. Providing health care coverage for everyone, while important, won’t automatically ensure the availability of health professionals and resources in rural communities. In a recent JAMA Forum piece, Diana Mason discussed the financial struggles of rural hospitals that support community health alongside primary care clinicians, which may become more acute if budget cuts to rural health programs and grants occur as proposed in President Trump’s budget.
The number of medical school and internships (a.k.a., “residency”) are limited by the Doctors Guild. They created these artificial barriers to entry to keep prices up — both the cost of medical school and the cost of medical care, which has to be high to pay off the loans required for medical school.
Doctors in such debt cannot go to rural communities and pay off the student loans the Doctors Guild required them to take out to become doctors.
This sounds like an artificial supply shortage. Many more people want to be doctors, and are capable to become doctors, than become doctors. You practically have to have a 5.0 in science courses at a great undergrad school to be admitted to Medical School. Why? The AMA caps the numbers of grads and internships to boost the average income of physicians.
Can you blame them? No. But is it right? No.
Sammy:
PCP income is still less than Specialists and there is a larger shorter of them now and going into the future. The issue(s) are what you said about allowing more candidates into medical schools which could also be resolved as you said. Dean Baker believes we should import more doctors and compensate the countries we take them from somehow and even though their is a larger shortage in some of these countries (not including much of Europe). Another fix for this is to train more NPs and PAs who could do more of the basics than PCPs (even they are charged with having to see patients) which would alleviate portion of the shortage issue. My experience with PAs and NPs has been favorable, more favorable than meeting the surgeons who I would have punched if possible.
Shortages are artificial and can be resolved. Either they do it or we force the issue. AMA memembership is <20% of all doctors.
Warren: “Doctors in such debt cannot go to rural communities and pay off the student loans the Doctors Guild required them to take out to become doctors.”
Precisely wrong. Doctors in rural areas actually earn more than doctors in cities because of the shortages. The reason that doctors don’t choose rural areas is because they prefer to live in cities with more amenities for highly educated people and more highly educated neighbors, even at lower pay.
How about a few facts for this blog.
Have you never heard of the National Medical Service Corps? The USG subsidizes the education of new MD’s with scholarships and repayments of student loans (up to $170,000) for those who will practice for specified time periods in rural areas,
You can google ‘doctors in Crawfordsville GA’ (the seat of the smallest pop county in the state) and find at least two.
Ed:
Welcome to Angry Bear. 1st comments are “always” moderated and approved so as to weed out the spam.
Your comment is true; however, there is still a shortage of doctors and PCPs. ACA was pushing for more PCPs.s.
“Dean Baker believes we should import more doctors….”
No argument there, but the Doctors Guild stands in the way of that, too, by requiring U.S. residency to become licensed. A co-worker’s wife is a Dentist, but was educated and licensed in Mexico. She cannot work as a dentist in the United States.
“Doctors in rural areas actually earn more than doctors in cities because of the shortages.”
I stand corrected. So why don’t more doctors move to the rural areas where they can be paid more?
Warren: “So why don’t more doctors move to the rural areas where they can be paid more?”
Because most highly educated people prefer to live in cities where there are lots of other highly educated people and cultural amenities that highly educated people value.
There is decreasing marginal utility to higher pay. Would someone who already makes a salary that puts you in the top 1% move to a non-preferred rural location for a 10% increase in pay? What’s the point of having lots of money if not to live the good life.
The reason most rural areas are sparsely populated is because most people don’t want to live there.
Interestingly, doctors in Massachusetts earn less than doctors in any other state. But we have among the highest number of doctors per resident of any state. Why, because of the high quality of life. Doctors come here for school and decide not to leave even though they could make more elsewhere. So it is not just money.
Fair point, Bill, Spencer. Any idea how to fix the problem?