It can be difficult enough to have an adequate supply of physicians in urban areas of the state where doctors have access to the latest technology at large hospitals. In rural areas, there simply aren’t enough doctors to go around.
“In Mississippi’s rural areas, access to healthcare — especially primary care physicians — is a growing concern,” said Shawn Zehnder Lea, vice president for strategic communications, Mississippi Hospital Association.
“University of North Carolina researchers have found that only 11% of physicians nationally are located in rural areas, but 20% of the U.S. is considered rural. And Mississippi is largely a rural population.”
In 2004, Merritt, Hawkins & Associates, a healthcare staffing and consulting firm, published, “Will the Last Physician in America Please Turn off the Lights? A Look at America’s Looming Doctor Shortage.” Lea said the authors predict there will be a shortage of 90,000 to 200,000 physicians and that average wait times for medical specialties are likely to increase dramatically beyond the current range of two to five weeks.
“Even before Hurricane Katrina, Mississippi was facing a shortage of physicians,” Lea said. “Findings presented in a 2003 white paper by the Health Policy Research Center at Mississippi State University indicate an ‘extant physician shortage will become more severe.’ Over half (56%) of the state’s physicians practice in four counties. Two out of three counties are officially designated health professional shortage areas (HPSAs) with high levels of chronic illness and poverty. A survey of practicing physicians indicates that many are considering relocation or early retirement which will likely exacerbate the current shortages.”
To address the situation, the Mississippi Hospital Association has focused on monitoring the J-1 visa program nationally and statewide. The J-1 visa program allows physicians from foreign countries to enter the U.S. to work in medically underserved areas.
“We are working with rural hospital administrators to make sure that they feel they have a sufficient supply of J-1 doctors and also monitoring national legislation that affects the program,” Lea said.
The Mississippi Delta has traditionally been a place where it is difficult to attract sufficient numbers of qualified physicians. Steve Nichols, CEO, Bolivar Medical Center, Cleveland, said while there is a shortage, it is not as critical for primary care at the present time as it is for specialists such as radiologists, ENTs, urologists, etc.
Nichols said that the hospital is working with local physicians to know their needs and work with recruiters to fill those needs.
Demographics aren’t in favor of the problem being resolved anytime soon.
“The shortage may worsen as Baby Boomers age and need more healthcare and as the physician population ages and retires,” Nichols said.
Dr. Michael O’Dell, director of the North Mississippi Medical Center Family Medicine Residency Center, Tupelo, said the current shortage of family physicians throughout the state is getting worse due to aging, retirement and fewer students being trained in family medicine.
“We are simply not keeping up with attrition of older physicians,” O’Dell said. “Physician shortages in rural areas worsen the problem of population loss and loss of industry in small communities. Adequate access to healthcare is an expectation. If access to healthcare is lacking, people may leave the community permanently in order to have needed care and others will not move to the community that lacks healthcare services. This can be a crippling problem for a community and severely handicaps economic development of the affected community.”
Family physicians are uniquely trained and prepared to provide care to a broad range of health issues.
“Because family physicians are so broadly trained, they are able to practice in rural areas where practitioners with more limited training would be unable to effectively practice,” O’Dell said.
In 10 years, there will be 75 million additional people on the Medicare rolls in the U.S. and there aren’t going to be enough family practitioners to take care of them, said
Dr. Randy Easterling practices family medicine and addiction medicine at the Street Clinic in Vicksburg.
“Nationwide, the U.S. is short about 400,000 family physicians,” said Easterling, who is past president of the Mississippi Academy of Family Practitioners. “When the four-year school of medicine opened in Jackson in 1955, Mississippi had the smallest ratio of physicians per population in the country. Fifty years later, we still have that distinction. There are fewer physicians for Mississippi than any other state in the country. This is seen even worse in primary care. We have a severe shortage in family medicine, general internal medicine and pediatricians.”
Many primary care physicians in Mississippi are aging, nearing the retirement age. Easterling said fewer and fewer primary care physicians are coming to take the place of retiring doctors.
A population with a high incidence of disease such as diabetes and heart disease is another barrier to recruiting and retaining physicians for rural areas, said Dr. Helen R. Turner, associate vice chancellor for academic affairs, senior associate dean in the School of Medicine and a professor of medicine at the University of Mississippi Medical Center.
“Just as the ‘Boomers’ flooded the school systems 50 years ago creating crowding in many schools within the nation and state, as elders they will need more and more medical care,” Turner said. “They will present an ever-increasing burden of chronic diseases such as hypertension, diabetes, heart disease, stroke and dementia. They will have benefited from new medical technologies and treatments for cardiovascular disease, cancer and AIDS that will enable them to live longer, but not necessarily healthier lives. They will, in fact, require more medical care, not less.”
Turner said other barriers to recruiting and retaining physicians in rural areas include lifestyle considerations that are important to younger physicians, both male and female. Medical students are graduating with higher debts that make them more inclined to opt for training in procedural specialties. In a two-career family, physician spouse preference may also play an important role in the decision to locate or not to locate in a rural area.
In response to the growing concern about a looming physician shortage nationwide, the American Association of Medical Colleges (AAMC) has gone on record as supporting increasing medical school classes by 30% over the next few years. Dr. Dan Jones, vice chancellor for health affairs at the University of Mississippi Medical Center and dean of the School of Medicine, has committed to increasing the medical school classes as resources allow.
“For many years, the School of Medicine admitted 100 students each year,” Turner said. “In 2005, 105 students were admitted and for 2006, 110 students have been admitted.
If additional resources can be identified, he hopes to increase the class size even more and also hopes to increase the number of residency positions.”
As important as it is to increase the size of the medical school classes and to increase the number of residency positions within the state, Turner said those things alone will not attract young physicians into primary care and into rural areas.
“Primary care physicians are the bedrock of our healthcare system,” Turner said. “These are the physicians who establish long-term relationships with their patients and provide a medical home. There is considerable concern that if widespread reform is not undertaken, in a few years there will not be enough primary care physicians to take care of the aging population. The current reimbursement system undervalues the provision of care in an ambulatory setting for physicians caring for patients with multiple chronic diseases, in relationship to procedural and technological services.
“Innovative programs for recruitment and retention of physicians are needed to overcome economic and social barriers that discourage young physicians from pursuing primary care, especially in rural areas. Both primary care and specialty physicians need to work together through organized medicine to decrease the economic gap between physicians who do procedures and those who do primary care.
Programs to facilitate early and personal relationships between medical students and communities should be developed. More scholarships need to be available to encourage medical students to commit to careers in primary care in Mississippi.”
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.
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