Soapbox

Doctor shortage in poor, rural areas needs to be addressed

Dr. G. Richard Olds
Dr. G. Richard Olds

Doctor’s appointments may soon be hard to come by. According to a new study, 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 the vast majority of newly minted doctors don’t end up practicing in these locales.

Medical schools must change this state of affairs – by pushing their graduates to practice in the communities that most desperately need them.

Rural areas in particular suffer from a dearth of doctors. About 20 percent of Americans live outside of urban areas, but only 9 percent of physicians do. In Mississippi, for instance, there are roughly 180 doctors per 100,000 people. For every 100,000 people who live in New York state, by contrast, there are about 349 physicians.

The issue is particularly acute when it comes to primary care physicians. For example, 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 currently being met.

Within individual states, the rural doctor shortage is especially pronounced. California, for example, 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.

Incentive programs can help steer some new physicians to communities in need. For instance, 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. According to one recent survey, participants in the loan repayment program are more than twice as likely to practice in a rural area than non-participants.

But these initiatives alone can’t remedy the doctor shortage in poor and rural areas. Medical schools must do their part, too.

They could start by admitting more 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 as early as 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 even 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 location. 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 after they complete their education.

The school I lead, St. George’s University, is putting this theory into practice. Our CityDoctors program, for instance, offers full and partial-tuition scholarships to students who go on to 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, former dean of UC Riverside School of Medicine, is president of St. George’s University in Grenada. Contact him at GROlds@sgu.edu.

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