Shortage of physicians in rural areas

In Alabama, close to 45% of the population lives in a rural area.{} For those people, finding a primary care physician is not always easy.

Approximately 25% of medical students choose to enter primary care. Of those, less than five percent practice in rural areas. Combine that with an increasing number of primary care physicians retiring and a growing elderly population and it's easy to understand why rural areas now face a shortage of family and general medicine physicians.

Dr. John Waits, is a family medicine physician with Cahaba Medical Care in Bibb County. The county has a population of 22,000.Waits says, he wanted to work where doctors aren't a dime a dozen."I didn't want to be somewhere in a suburban practice. I wanted to be somewhere there was a need," says Waits.Waits has served the community for the last decade. He'll be the first to admit, being a physician in a rural setting can be demanding. "It's very busy," he says. "The demands on time are very overwhelming, which is a part of being a rural physician."That demand won't be going away any time soon."There's a gap that we aren't even close to filling right now, so it's a big problem," says Dr. Bill Curry, associate dean for primary care and rural medicine at UAB.

Curry says the university is working on ways to relieve that gap. "What we are doing is trying to increase the pipeline of students who are likely to choose primary care and rural medicine," Curry explains.Curry says one way to fix the problem, is for medical schools to open up more residency programs in rural areas. Dr. Waits has four residents currently working at his clinic in Bibb county,"A student from a rural community is four times more likely to wind up practicing in a rural community than someone who grows up here in Birmingham," says Curry.However, Curry knows the clock is ticking. Primary care physicians are aging many are close to retirement."We're not going to have enough in the next ten years as that demand increases. Even if we stay at the current rate of supply, or even if we increase that supply by 30 to 40 percent, we're still going to have a gap," says Curry.Curry says perhaps the best way to bring more students into primary care is by changing the pay structure in medicine.

Primary care currently operates under a fee-for-service model. Waits agrees. "There has to be a reform in the way that physicians, and hospitals and how everyone is reimbursed. And this is a very common topic over the last five years in our country, but we can't continue to be paid per visit in the office, there's so much healthcare that happens on the telephone and outside the office or just preventive care," he says.Ultimately, Curry says it's going to take the work of many moving parts to provide medical care to underserved regions. "We have to partner with nurses, with nurse practitioners, physician assistants, pharmacists, social workers. The evolving model now, is to work in teams with everybody doing the most that they can in order to get the care to the patients as they need it," he says.