Indiana tangles with shortage of rural doctors

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Health care advocates in Indiana are looking at an improved training system for physicians and an expanded concept of what it means to see a doctor to help serve what's expected to be a crush of new patients seeking care starting next year.

Millions of people without health insurance nationwide are set to gain coverage in 2014 as part of the federal health care overhaul, commonly referred to as "Obamacare." As in many states, that will exacerbate problems in Indiana surrounding access to care in rural communities where is there is already a shortage of doctors and other health care providers.

"I think there's especially concern about the looming retirement of a lot of older physicians, and the expectation is because of that, and the expansion of health care, those factors will combine to make the existing shortage even more acute," said state Rep. Ed Clere, R-New Albany, the chairman of the House Public Health Committee.

The state only recently determined the depth of the shortage. The passage of the health care law in 2010 exposed the lack of information in the state about availability of health care, and it took two years to compile a comprehensive report, said David Roos, executive director of the advocacy group Covering Kids and Families of Indiana.

Indiana has 3,951 primary care "clinicians," a catch-all description that includes physicians, physician's assistants and nurse practitioners, according to an August 2012 report written by researchers with the Indiana Center for Health Workforce Studies and Bowen Research Center at the Indiana University School of Medicine.

The goal for states is to have 100 primary care physicians available for every 100,000 residents. Researchers found Indiana only had 51, and the number drops precipitously in rural communities, said Dr. Richard Kiovsky, director of the Indiana Area Health Education Centers.

Kiovsky said one possible solution is to start training doctors in the areas where there are acute shortages. Doctors are more likely to stay in a community where they grew up and went through their medical training than they are to move back home to practice after training somewhere else, he said.

As a result, groups such as the Indiana Rural Health Association are trying to get students in rural communities interested in medicine at an early age and guide them along through medical school.

"The focus is to create a training and recruitment program which literally start in grade school and ask, 'Have you ever thought about becoming a doctor when you grow up?'" Roos said.

Another answer is to adjust attitudes about who patients should see when sick. Kiovsky said if a physician's assistant can do the job as well as a fully-trained physician, that should be an option. Clere points to the industry term "extenders," or workers who literally extend the ability of doctors to take care of more patients.

"What's important is that we make sure patients are receiving high quality care from an appropriate provider," Clere said. "So there's a screening process that goes on. If the issue is beyond the scope of a physician's assistant and a nurse practitioner, then we need to make sure there is a physician available to see the patient."

In the meantime, Kiovsky said he is working with state lawmakers to further study the issue and propose changes which will make it easier to train more physician's assistants and nurse practitioners.

"The future of health care is going to be team-based," he said. "Not every person who comes in is going to need the physician's services, there are some offices that can be easily handled by a physician's assistant."


  • Residency Programs, not Medical Schools
    There is no point to increasing the number of medical schools. Once future docs finish medical schools, they have to complete a residency program. Since congress hadn't increased the number of residency slots available in decades, there is a bottle neck where people graduate from medical school, but can't secure a residency. Tell congress to increase the number of residency slots and focus on increasing the number in areas with the most need.
  • Doctor shortage
    Even if the number of physicians was increased, how many would choose to live and raise families in the under served counties? After all, they are under served for a reason.
  • How to lie with statistics?
    @philiptoth: the number of medical schools is irrelevant, it's the number of students that matters. For instance, IU School of Medicine is Indiana's only allopathic medical school, but it's very large. IU takes over 300 students a year, more than UK (about 115) and Univ. of Louisville (160) combined. I agree that Indiana needs more graduates, but basing adequacy on the number of schools is silly.
    • more than one
      @phillip Marian U. now has medical school. also unfair to count Indiana as 1 medical school. they have campuses all over the state, including south bend which considers its students of Notre Dame. Other campuses include Indianapolis,Bloomington,Fort Wayne,Terre Haute,Lafayette,Gary,Evansville,Muncie Long lines, long waiting periods, shortage of doctors, lower health care standards, and quality of care and medical options available will all be result of Obamacare, if its successful. right now obama can't sell it, is hoping the NBA and NFL will help sell to young population or else premiums will skyrocket and it will collapse under its own weight. Meanwhile, with everything going on in this country, Obama is busy making global warming speeches?? Obama has completely failed and his incompetence is getting noticed even by low info crowd
      The solution has been clear for years. Our State should be supporting more medical schools. An improvement is the Marian DO medical school. Look at our surrounding States. Illinois - 7 medical schools Ohio - 6 medical schools Michigan 4 medical schools Kentucky - 2 medical schools Each of the States also have a DO medical schools as well. Purdue and Notre Dame would be two obvious choices for a medical school.
      • Loan Forgiveness
        Wouldn't it also be highly effective to have the State provide some loan forgiveness after physicians have provided primary care services in underserved communities for a specified length of time. It seems to me that there would be many physicians who feel that loan forgiveness early in their careers combined with the lifestyle benefits of rural living would offset the loss of wages they will suffer by not practicing a specialty in the city.
      • Fewer doctors is a good thing, right?
        From 1997 - An excellent example of why government control of healthcare is bad for healthcare. What changed? The cockeyed rationale was reduce the cost of healthcare by limiting the number of providers. When has a reduction of providers in any market reduced prices? "August 25, 1997|By AMY GOLDSTEIN; Washington Post WASHINGTON — The federal government has agreed to pay hospitals around the country hundreds of millions of dollars not to train doctors in a highly unorthodox initiative aimed at alleviating a growing glut of physicians. The initiative, embedded in the new federal budget agreement, extends to all 1,025 of the nation's teaching hospitals an offer similar to a controversial experiment approved for New York earlier this year."

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