Rural primary care shortage growing
by Patrick McCreless
pmccreless@annistonstar.com
Jun 20, 2012 | 1176 views |  0 comments | 9 9 recommendations | email to a friend | print
A desire to help the elderly lured Dr. Arden Aylor to practice primary care in the area. For two years, he has served the local community, most recently with the Talladega Primary and Urgent Care Center, owned by Regional Medical Center.

But though Aylor has enjoyed the work, it has not been easy.

"I like it — I've got a passion for senior citizens," Aylor said. "The problem is you can't see people fast enough."

Aylor is not the only rural primary care physician facing a growing demand for his services.

According to a new report in the June edition of the journal Academic Medicine, fewer U.S. medical students are choosing to enter primary care — about 25 percent — and of those only 4.8 percent practiced in rural areas. Combined with an increasing number of primary care physicians seeking retirement and a growing population of elderly residents, health industry experts say rural areas like Calhoun County face an increasing shortage of family and general medicine. Experts add that though some efforts are underway to address the problem, so far it's not enough.

While the entire country faces an increasing shortage of primary care physicians, the problem is particularly bad for states like Alabama, which is mostly rural. According to statistics from the Health Resources and Services Administration, 55 of Alabama's 67 counties, including Calhoun County, are considered rural and 44.4 percent of the state's population live in rural areas. The statistics also show that 61 of Alabama’s 67 counties, including Calhoun are short of primary care physicians.

Dr. William Curry, associate dean for primary care and rural medicine at the University of Alabama at Birmingham, said the primary care shortage is a serious problem for Alabama.

"Alabama is probably disproportionately affected because it's so rural and has so many more poorer residents," Curry said.

Curry said the lack of money is mainly luring medical students to specialty fields instead of primary care.

"A primary care physician makes somewhere in the range of 50 percent to 60 percent of what a doctor in a specialty field makes these days," Curry said. "And medical students are having increasing debt."

Aylor agreed with Curry, saying primary care physicians receive lower reimbursements from private insurers and the federal Medicare and Medicaid programs.

"You don't have to get rich, but you've got to be at a point where you're attracting people to join," Aylor said.

Maggie Elehwany, vice president of government affairs for the National Rural Health Association, said the lack of new primary care graduates is only part of the problem.

"We've got an aging physician population getting ready to retire," Elehwany said.

Aylor has not practiced primary care in the area long and yet he has already seen his field of contemporaries shrink.

"We've got a lot of older doctors who have been established in the area that are starting to retire," Aylor said. "I've only been here a year or two and already I'm seeing many friends retire."

The amount of aging physicians is part of the growing elderly population of baby boomers, which is increasing demand on primary care doctors.

"This will be the largest elderly population in our nation's history," Elehwany said.

Elehwany said one way to lessen the physician shortage is for medical schools to open up more residency programs in rural areas.

"Every study of students shows that those that are placed in rural residency programs tend to stay in rural areas," she said. "But right now medical schools are not focusing enough on residency programs in rural areas."

Curry said UAB in recent years has made more efforts to place students in small-town, rural areas at family internal medicine clinics. Curry said changing the pay structure in medicine could also lure more students to the primary care fields. He said primary care operates under a fee-for-service model.

"That puts all the incentive on patients showing up to the doctor's office when a lot of what they need really involves information provided over the phone or email or just home-based care," Curry said. "Patient-centered medical home-based care ... that is the model for how to do this."

Curry noted that though the Affordable Care Act federal health care reform passed in 2010 addresses the shortage of primary care physicians somewhat, it does little in regards to pay reimbursements.

Elehwany said telemedicine — technology that allows physicians to diagnose and consult with patients from a distance — could help lessen the primary care doctor gap.

"It can allow a physician in an urban area to monitor a rural patient for a relatively low cost and the benefit for the patient is not having to travel," Elehwany said. "But telemedicine is being under-utilized right now because there are so many red-tape hurdles with reimbursement rates and licensing ... there need to be changes to federal and state laws."

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.

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