November 9th, 2017
The lack of primary care doctors in rural areas is immensely detrimental to the health of America’s rural residents, who already face significant socioeconomic, health, and transportation challenges. While 19.2 percent of the U.S. population lives in rural America, only 11.4 percent of physicians practice in rural locations. And there are vast inequalities between states in access to primary care; according to the latest State Physician Workforce Data Report, in 2016 Massachusetts had 134.4 primary care doctors per 100,000 people, while Mississippi had 64.4 and Utah had 64.7.
States have used different tactics to try and retain physicians in their states, including forgiving student debt for doctors that practice in underserved areas in the state, building new medical schools in rural areas, and funding more slots for medical residents.
But there is still much more we could be doing to increase the number of primary care physicians in rural areas. Currently, young physicians have little incentive to choose primary care, financially speaking. Why not make medical school free for students who go into primary care and keep practicing primary care after residency? This would cost $2.5 billion a year, which is less than Medicare spends on a single cholesterol drug. “Making medical school free would relieve doctors of the burden of student debt and gradually shift the work force away from specialties and toward primary care,” wrote Dr. Peter Bach and Dr. Robert Kocher in The New York Times.
Another strategy is increasing the number of students from rural backgrounds who go to medical school in the first place. Students from rural areas are underrepresented in medical school, in part because “the competitiveness of medical school admissions favors kids from rich backgrounds who go to elite high schools and colleges,” says Lown Institute vice president Shannon Brownlee. We can start to correct this with targeted outreach and prep courses for students in rural areas, and by adjusting admissions policies to give credit for geographic diversity, writes rural health care expert Dr. James Rourke in the World Health Organization Bulletin. Because students from rural backgrounds are more likely to be low-income, making medical school more affordable would also help increase their representation in medical schools and, hopefully, in clinical practice.
Health care access in rural America is approaching a crisis. And yet our government has been going in the opposite direction, allowing funding for community health centers to expire instead of investing more in care for underserved communities. We need a more radical approach to rebalance physician supply and demand geographically. Creating pathways to medicine for students from rural backgrounds and providing a strong financial incentive to choose primary care would be a good start.