Here’s a quick rundown of the study. To read the entire document, go to http://depts.washington.edu/uwrhrc/uploads/RHRC_FR125_Rosenblatt.pdf .
Rural locations rely heavily on family physicians who account for about half of all rural physicians in large rural areas and about two thirds in smaller and more isolated areas.
There has been a sharp decline in the proportion of U.S. medical graduates choosing family medicine over the last decade, with most family medicine residency positions filled by students who graduated from medical schools outside of the United States.
The proportion of students choosing family medicine careers will likely remain far below the numbers required to replace rural and urban family physicians leaving the field because of death or retirement.
The pipeline to attract physicians to rural primary care is dysfunctional; rural youth are not recruited to medical school; women, who make up an increasing percentage of physicians, and international medical graduates, are not attracted to rural living.
The report details several private efforts and federal and state policy options that could help increase and sustain the number of family physicians in rural practice including:
Making it more attractive and financially viable for physicians to practice in rural areas through programs such as improved Medicaid reimbursement, practice development subsidies, tax credits for rural/underserved practice, locum tenens support, malpractice immunity for free care, payment bonuses, subsidies for electronic health records, and Medicaid reimbursement of telemedicine.
Increasing the number of medical students recruited from rural communities by providing education and support that would prepare them for medical careers.
Changing medical school curriculum and admission policies to admit more students from rural backgrounds, providing financial support and helping disadvantaged students get into medical school.
Providing financial support for residency programs that train rural physicians through rural practice training tracks, and focusing on the skills required to succeed in rural practice.
It’s rewarding to see locum tenens recognized as part of the solution to the shortage of rural primary care physicians because, in fact, the locum tenens industry in the US was established to provide respite to rural providers.
In 1976, Therus Kolff, MD, MPH, and colleagues at the Health Systems Research Institute, a non-profit formed by the University of Utah, the Intermountain Regional Medical Program, and the Robert Wood Johnson Foundation set out to develop innovative solutions to rural healthcare challenges. Dr. Kolff led a team that managed 22 clinics and five hospitals in nine western states and served as team leader for Yellowstone National Park Medical Services.
This team realized that their physicians were at risk of quick burnout because they were on call essentially all the time and never felt they could get away from their practices. They decided they needed a “circuit rider” to provide coverage and give these doctors time off with the peace of mind that their patients would be cared for and their practices managed responsibly. Dr. Kolff went on to establish the first commercial locum tenens company in 1979, and is currently a medical director for VISTA Staffing Solutions.