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Rural America Gets Creative to Attract Much-Needed Doctors

"Training in 'the sticks,' sticks," says one medical professional. But first, rural areas have to get doctors there.

Rural Doctors Refugees
Benjamin Anderson, CEO of Kearny County Hospital in Lakin, Kan., points to a board showing filled and unfilled positions.
(AP/Orlin Wagner)
Because of the Affordable Care Act, more Americans have health insurance than ever before. But having insurance doesn't necessarily make it easy to find a doctor when much of the United States is suffering from a shortage of physicians.

According to the Kaiser Family Foundation, there are almost 7,000 areas around the country with an inadequate number of primary-care providers. In the next decade, the country could be short 95,000 doctors, according to a study last year by the Association of American Medical Colleges. It's an issue that affects urban and suburban areas to a degree, but it's the nation's rural areas that tend to be hit the hardest. 

Projected 2025 Shortage/Surplus

SOURCE: U.S. Department of Health and Human Services, "State-Level Projections of Supply and Demand for Primary Care Practitioners"
To lure more doctors to the places that need them, several states are getting creative. 

The majority of physicians (68 percent) stay in the place they complete their residency, the year following graduate school when they work under the supervision of licensed professionals. That statistic is the driving force for David Schmitz’s work.

As chair of the Department of Family and Community Medicine at the University of North Dakota (UND), Schmitz's mantra for solving the rural doctor shortage is: "Training in 'the sticks,' sticks." In other words, if a doctor is trained in a rural area, she's likely to practice there as well.

Schmitz helps run ROME, the Rural Opportunities in Medical Education program, which allows third-year students at UND's medical school to spend up to seven months in one of five rural sites. He also helped pioneer a questionnaire that helps the state's rural hospitals identify their strengths and weaknesses in recruiting physicians. 

“It covers questions from ‘how’s the shopping?' to ‘how’s the education system?’" says Schmitz. "If you see, for instance, that everyone is upset with the electronic health records within the hospital in a unique way, then you can work on that."

But "one of the best approaches" to address doctor shortages, at least according to Alan Morgan, CEO of the National Rural Health Association, was pioneered by Missouri. In 2014, the state passed a law that allows "assistant physicians" -- graduates of medical school who haven’t been placed in a residency program yet -- to practice medicine in underserved areas under the supervision of a fully licensed doctor. The role doesn't count as a residency, but assistant physicians can work indefinitely if they like their job.

As of May 2017, 23 assistant physicians have been placed somewhere in the state. That number is expected to rise because the state didn't even start accepting applications until this year. 

Meanwhile, Arkansas, Georgia and Texas have passed laws in recent years to increase the number of residency programs at rural hospitals.

Solutions like these, says Morgan, are the only way to ensure Americans in rural areas have adequate access to care.

“In rural America, you’re not going to have the same salary. These kids have a lot of debt. Communities need to be turning inward. You have to be creative,” he says.  

For Benjamin Anderson, CEO of Kearny County Hospital in Lakin, Kan., attracting doctors is about creating an atmosphere where they feel welcome.

“Rural communities don’t always open themselves up. Millennials deeply desire community, and when a young family comes to a rural place, they’re vulnerable,” Anderson says. “Hospital CEOs often see physicians as workhorses, but when we draft up an employment contract, we ask, ‘How can we protect your family?'”

Being a doctor at Kearny County Hospital also comes with perks. Since Anderson came on board in 2013 to attract more doctors, physicians there now get six weeks' paid time off to do mission work anywhere around the world. While this can be controversial, Anderson emphasizes that no doctors are giving medical advice based on religious opinion and says it does benefit doctors when they return home. For one thing, the next closest town, Garden City, Kan., has a large immigrant population.

“Our physicians can say, ‘I love you, I care about you,’ in a practical way," says Anderson. "They’ve seen where [their patients] come from. There is a cultural competency there."

Mattie covers all things health for Governing.

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