Getting doctors to rural communities

Editorial: Getting doctors to rural communities

Rising tuitions, lack of incentives are creating a shortage in primary care physicians that's nearing a critical stage.

By The Denver Post

Posted: 07/03/2011 01:00:00 AM MDT

A looming shortage of primary care physicians in Colorado — and around the country — is a knotty problem that calls for creative and careful policy prescriptions.

Already, Colorado needs nearly 200 more family doctors, mostly in rural areas. In a few years, as national health care reform kicks in, that doctor shortage will double.

The trend has not gone unnoticed by the state's policymakers and educators, who've taken steps to offer financial incentives and special courses of study to coax prospective doctors into primary care.

Their efforts will narrow the gap, but more must be done to ensure inner-city patients and those living in rural areas can see a doctor when they need to.

In Colorado, part of the problem is the cost of medical school. In-state tuition and fees at University of Colorado's medical school have more than doubled in the last decade. That figure for the 2010-11 school year was a whopping $33,089.

The increases in costs for those who go to CU's medical school at the Anschutz Medical Campus in Aurora are directly related to a trend of deep cuts to higher education funding in Colorado. Upon graduation, medical students leave with an average of nearly $140,000 in debt — and a need to make money to pay it off.

That's one of the motivations for taking up lucrative specialties paying two to three times more than primary care.

CU's medical school has spent much of the past decade getting programs up and running to identify, educate and encourage students to go into primary care in underserved urban and rural areas.

Jack Westfall, associate dean for rural health at CU's medical school, says there are now some 35 students each year in these tracks, about 15-18 percent of each class of medical students.

Admissions preference is given to students who grew up in rural or underserved urban locations in Colorado, and students are taught some of the idiosyncrasies of practicing in these areas.

While the programs are a good start, it still will take some years and additional effort to meet the growing need for primary care doctors.

More funding for medical school and residency training programs, and federal and insurance reimbursement systems more favorable to primary care, also would help the situation.

Loan forgiveness for medical school debt is another way of addressing the economic incentives of practicing in primary care.

Colorado does have a loan forgiveness program through the Colorado Health Service Corps. It awarded $2.5 million in 2011 to a variety of health care professionals who commit to practicing for three years in an underserved area. This, too, is a good start, but not enough to eliminate the doctor shortage.

Primary care is an important foundational piece of the future of health care in this country, and more must be done to ensure there are enough doctors to provide it.