Health reform puts pressure on physician training
Posted April 21, 2010
Chapel Hill, N.C. — As more people obtain health insurance under new national reforms, some areas are expected to see physician shortages.
The nation will need an extra 40,000 family practice physicians and another 150,000 specialists and surgeons by 2020, according to the American Association of Family Practitioners. Geography could make the problem even worse, the group says, noting that only 11 percent of America's doctors currently live in rural areas.
"Increasing the availability of insurance doesn't always equate to increasing the access to a physician," said Dr. Tim Daaleman, vice chairman of the Department of Family Medicine at the University of North Carolina School of Medicine.
Tyrrell County had no primary care physicians – family practice doctors, pediatricians, ob-gyns and internal medicine doctors – in 2008, the most recent year for which data are available. Another 26 North Carolina counties, including Edgecombe, Franklin, Halifax, Harnett, Hoke, Johnston and Warren, have five or fewer primary care physicians per 10,000 residents.
"If we can develop the training programs that respond to those needs, those would be good," said Dr. Tom Ricketts, deputy director for policy at UNC's Cecil G. Sheps Center for Health Services Research.
The North Carolina Medical Society Foundation's Community Practitioner Program recruits physicians to under-served areas in exchange for paying off up to half of their outstanding student loans, medical society spokesman Mike Edwards said. More than 70 percent of the physicians choose to remain in those communities after fulfilling their commitment under the program, he said.
Most of North Carolina's physicians are trained elsewhere before moving to the state, Ricketts said. Fewer North Carolina natives pursue medical school training than in other states, he said.
Plans to expand the state's medical schools with satellite programs were put on hold because of the economy, UNC President Erskine Bowles said.
"We are still going to have a need for doctors, and we'll have to catch up sometime down the road," Bowles said.
Dr. Andy Babcock is about to finish his residency at UNC, and he plans to practice as a primary care physician in Raleigh.
"I really felt a very strong connection with spending time with patients over long periods of time and building continuity," Babcock said.
Ricketts said North Carolina isn't as bad off as other states and predicted the number of physicians statewide will increase in the coming years.
"North Carolina is actually going to gain docs over the coming five (to) 10 years," he said.
Another possible solution to ease area shortages is to expand the role of nurse practitioners.
North Carolina is one of 28 states considering expanding their authority, but physicians are generally opposed to the idea. The American Medical Association has dispatched doctors to a number of state legislatures to lobby against it.