Rural Areas of the United States Facing Shortage of Primary Care Doctors
The 2011 ‘Montana Healthcare Workforce Statewide Strategic Plan’ published by the Montana Office of Rural Health had hinted about the shortage of primary care physicians (PCPs) in Montana’s counties during 2010. The report said 11 counties had no PCPs and 16 counties had five or fewer PCPs. The estimates of the Health Resources and Services Administration (HRSA) and the Association of American Medical Colleges (AAMC) suggest that this scenario remains unchanged and will continue to persist in future. As per HRSA, a total of 5,991 Health Professional Shortage Areas were designated for primary care as of January 1, 2014 while the AAMC predicts a shortage of 45,000 primary care doctors in the United States by020.
Reasons for Physician Shortage and How Hospitals Manage it An article published in the Great Falls Tribune clearly depicts the shortage of PCPs in remote areas, reasons for the shortage, and how rural hospitals are managing the shortage. It is reported that the lower-paced environment in small towns and the efforts needed for maintaining proper emergency room and clinical coverage are among the challenges that PCPs face. However, the main reasons for the shortage of doctors in rural areas are as follows
Many medical graduates are reluctant to choose primary care as their field. According to a study by the Washington-based Robert Graham Center for Policy Studies in Family Medicine and Primary Care and the George Washington University School of Public Health and Health Services, the average overall primary care production rate was 25.2% when the number of medical graduates from 2006 to 2008 was measured. No primary care graduates were produced from 158 institutions among the 759 sponsoring institutions surveyed.
When debt rises, economics plays a major role in medical graduates’ decision on specialties and areas of practice. According to the AAMC, the average debt for graduates in debt in the 2013 class was $169,900.
PCPs who graduate from medical school and complete their residency program usually prefer populated areas for their practice as they are well paid there.
Compared to specialists, PCPs make a significantly smaller amount. The report released by the New England Healthcare Institute in 2010 says that family practice, pediatrics and internal medicine are the three lowest paid medical fields. This is another reason why medical graduates are reluctant to choose this field.
The New England Healthcare Institute report found greater workloads and job burnout to be the main reasons why general practice physicians left the primary care field.
Rural hospitals are taking several measures to manage the PCP shortage and ensure better care for rural patients. Rural hospitals are employing more mid-level practitioners (family nurse practitioners and physician assistants) for primary care to fill the PCP gap. They also maintain a strong working relationship with the larger regional healthcare system so that the specialists from bigger institutions can visit rural patients regularly and doctors from larger healthcare facilities become available for rural hospitals through the telemedicine facility. Sometimes, two hospitals join forces to shift emergency patients. The WWAMI Regional Medical Education Program of the University of Washington School of Medicine in partnership with the four western states (Wyoming, Alaska, Montana and Idaho) also help to fill the gaps of PCPs by spotting students interested in rural medicine and encouraging them to practice in remote areas. Loan Forgiveness Programs for primary care doctors practicing in rural or underserved areas also encourage PCPs to stay in their field. How will the PCP Shortage affect Medical Transcription Jobs Most medical transcription jobs are held by people working for hospitals or physicians’ offices. Several third-party transcription service companies provide transcription services for healthcare establishments. As per the U.S. Bureau of Labor Statistics, medical transcriptionists held around 84,100 jobs in 2012 and more than
half are employed in hospitals (34%) and office of physicians (24%). So the shortage of PCPs in rural areas could lead to the loss of medical transcriptionist jobs. However, this does not mean the demise of medical transcription. Medical transcription is still relevant especially in the situation when rural hospitals are having a hard time in implementing Electronic Health Records (EHRs). Financial and administrative burden with EHRs are putting rural practices at risk while second stage of ‘meaningful use’ of EHR begins on 2014. It is quite challenging to maintain accurate data within EHR as the point and click templates cannot generate a complete, concise and informational data. Many physicians use copy-and-paste facility routinely to save the time dedicated for patient care. It has been found that the unrestricted copy-and-paste facilities make physicians input wrong data by mistake. Rural practices may face claim denials due to these errors. The combination of EHR and transcription can help physicians in these practices improve productivity and revenue.