Rural communities face a shortage of primary care physicians

By Liz Carey

A new study from the American Academy of Family Physicians Robert Graham Center (AAFP), co-funded by the Milbank Memorial Fund and The Physicians Foundation, has found that communities across the country are also struggling to meet the demand for primary care physicians. to retain these doctors in their communities. While it’s hard everywhere, said Dr. Yalda Jabbarpour, the study’s lead researcher, it’s harder for rural communities.

Ten years ago, we knew we had a problem with primary care physician density, Jabbarpour said in an interview with the Daily Yonder. Today, even though people are older, and therefore sicker, and the population is growing and the demands are greater, we actually have fewer doctors to fill that need.

Rural communities tend to rely more on primary care doctors, Jabbarpour said, especially family doctors.

In 2021, 37% of all physicians-in-training (residents) began training in primary care, but only 15% of all physicians were practicing primary care three to five years after residency , the study found.

The research showed that more than half of those residents with potential to enter primary care subspecialized or became hospitalists. And only 15% of primary care residents spent most of their time training in ambulatory settings where the majority of the US population receives their care, and less than 5% of primary care residents spend time training in rural and other underserved communities, the researchers found.

The AAFP study also found that there is a slightly higher density of primary care providers in rural and underserved areas. By looking at the social determinants of health such as housing, transport, income and education and how they affect the health status of residents, the study found that people in areas with the most social disadvantages (housing less adequate, barriers to transportation, and lower income, for example) had higher rates of chronic disease and worse health outcomes.

In 2021, the overall primary care density in the most socially disadvantaged areas was 111.7 per 100,000 inhabitants, while the density in the least socially disadvantaged areas was 99.5 per 100,000. However, the researchers said, while these measures are hopeful, they are still insufficient.

This finding can be attributed, in part, to the success of the community health center movement, which aims to place doctors in areas of greatest social need, the researchers said. Still, this promising finding must be tempered by the reality that even this higher density of primary care physicians may not meet patient demands, as people living in high-need areas tend to have higher levels of medical necessity.

Jabbarpour said rural areas are doing a much better job of training and retaining the primary care workforce, but at the same time, it’s still not enough to meet the growing demand.

Family medicine, like any other medical specialty, he said, is distributed just like the US population. Rural areas across the country, according to the US Census Bureau, are home to 19.88% of the total US population. Jabbarpour said a corresponding percentage of primary care physicians would be in a rural area. But because rural communities tend to be statistically older and sicker, the need in rural communities is greater.

The study found that one way to solve the problem would be to invest more in primary care. Shifting the overall share of health care spending by the Centers for Medicare and Medicaid (CMS) to primary care would help invest more federal dollars in primary care, as would the US Department of Health and Human Services’ (HHS) investment in a new rural health clinics, health centers and Indian Health Service (IHS) facilities in shortage areas, the report said.

The U.S. is underinvesting in primary care, and Medicare’s fee schedule that lists fees for services is the main culprit, according to the report. It undervalues ​​primary care services relative to specialty services and pays per visit, discouraging non-visit services such as emails and phone calls, as well as care from other members of the primary care team.

Jabbarpour said another key to getting more primary care doctors into rural communities is for universities to hire from rural communities.

Medical schools should recruit from those communities because people tend to go home to practice, he said.

Bringing doctors to rural areas also means helping their spouses find work.

There are doctors who want to go to rural areas, but their partners don’t have opportunities to work in rural areas if they’re not also in medicine, he said.

The biggest way to bring primary care doctors to rural areas, he said, was to expose them. Research has found that doctors who train in teaching health centers and rural training tracks are more likely to practice in these communities.

I know that not all rural areas are created equal. In some rural areas, it’s probably an area where doctors would love to live and raise their families if they knew, he said. I know this is difficult because this requires hospital systems to actively recruit or establish rural training tracks, and reach out to medical schools across the country and say, hey, send your students here, give them a home and can be exposed to it. beautiful piece of heaven we have and then they will want to come here.

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