Where There Is No Doctor
By G. Richard Olds
Doctor’s appointments may soon be hard to come by. The United States will be short up to 90,000 doctors by 2025.
This shortage will hit rural and poor urban areas hardest, largely because most newly minted doctors don't practice in these locales.
Medical schools must change this state of affairs by pushing their graduates to practice in the communities that need them most.
Rural areas in particular suffer from a dearth of doctors. About 20 percent of Americans live outside of urban areas; only 9 percent of physicians do. In Mississippi, there are 180 doctors per 100,000 people. For every 100,000 people who live in New York State, by contrast, there are 349 physicians.
Even within individual states, the rural doctor shortage can be pronounced. California has 86 primary care physicians per 100,000 residents in the mainly urban San Francisco Bay Area -- but just 48 per 100,000 in the largely rural San Joaquin Valley and 43 per 100,000 in the Inland Empire east of Los Angeles.
The issue is particularly acute when it comes to primary care physicians. North Dakota has only enough doctors to meet 37 percent of its primary care needs; a mere 30 percent of Missouri's primary care needs are being met.
Incentive programs can help steer physicians to communities in need. The federal government's National Health Service Corps offers scholarships and loan repayments to physicians who agree to practice for at least two years in an underserved area. Participants in the NHSC loan repayment program are more than twice as likely to practice in a rural area as non-participants.
But these initiatives alone can't remedy the doctor shortage. Medical schools must do their part.
They could start by admitting students who are likely to work in underserved locales.
Consider the University of Kansas Medical School, which begins recruiting potential doctors for its "Scholars in Rural Health" program during their sophomore year of undergraduate studies. Students must demonstrate that they want to become physicians and commit to work in underserved areas. Successful candidates are guaranteed admission to the University's medical school and can qualify for a program that pays their tuition and board.
Schools can also familiarize students with underserved communities. Over 80 percent of doctors stay within 50 miles of their residency. If medical schools team up with rural or inner-city hospitals to establish residency programs and clinical partnerships, then the doctors who train there are likely to remain to practice afterward.
The school I lead, St. George's University, is putting this theory into practice. Our CityDoctors program offers full and partial-tuition scholarships to students who practice primary care at public hospitals in some of New York City's most disadvantaged communities.
The doctor shortage in poor and rural communities won't fix itself. Med schools must do their part to address it by recruiting medical students who want to serve in these areas -- and training them to do so.
Dr. G. Richard Olds is the president of St. George's University in Grenada. This column was originally published in the Sacramento Bee
