Addressing physician shortage in rural areas

Certain osteopathic medical schools uniquely suited to combat this crisis, even more so than their conventional allopathic counterparts.

By Ben Keeton

 

The Association of American Medical Colleges recently released its latest estimate of our nation’s looming doctor shortage. By 2025, America could be short more than 35,000 primary-care physicians. That’s 4,500 more than the group projected last year.

Local Solutions

Many schools in our area are doing something about this projected shortage with significant medical school partnerships cropping up. For example, four academic institutions have agreed to open a collaborative campus in Evansville, Indiana, to promote health science education and develop a medical school compound. The participating schools are: Indiana University, University of Evansville, University of Southern Indiana, and Ivy Tech Community College.

Also, the University of Kentucky recently announced a partnership with Western Kentucky University and Morehead State University that will increase its class sizes by 30 percent. The schools are uniting to help address the rural medical shortage in the region.

Osteopaths Step In

Certain osteopathic medical schools are uniquely suited to combat this crisis, even more so than their conventional allopathic counterparts. In short, osteopathic schools churn out a lot more primary-care docs. A majority of graduates from DO programs go into primary care.

Features_Ross-LeeWe sat down with Dr. Barbara Ross-Lee, NYIT (New York Institute of Technology) vice president for Health Sciences and Medical Affairs and site dean for NYIT College of Osteopathic Medicine at Arkansas State University, to get her take on why osteopaths will be the ones to fill America’s doctor shortage.

Medical News: What is unique about osteopaths and why will they be the ones to fill America’s doctor shortage, especially in a rural setting?

Dr. Barbara Ross-Lee: Osteopathic physicians are no longer accepting of the title osteopaths. Doctors of Osteopathic Medicine are fully licensed physicians in all 50 states and territories. Osteopathic Medical practice is no longer limited to the musculoskeletal system (as is Chiropractic) and hasn’t been for decades (over 60 years).

Osteopathic physicians practice full scope medicine, meeting the same licensure requirements as MDs (Allopathic physicians). Thus, there are two types of physicians in this country – MDs and DOs.

The osteopathic profession is growing rapidly. It is estimated that one out of every four physicians in training is osteopathic. The profession achieved its current status through a different educational pathway than MD. Osteopathic physicians receive their education in osteopathic medical schools and/or community based hospitals located in underserved and rural communities.

The educational model that is derived from the Osteopathic Philosophy (structure related to function, holistic care, mind-body-spirit, and an emphasis on primary care and prevention) utilizes greater proportions of generalist physicians in the education of matriculating students. Additionally, osteopathic medical students are taught through many additional required hours in the curriculum to use their hands to diagnose physical problems, communicate caring through touch and treat musculoskeletal and viscero-somatic problems.

Because of where the student education takes place, the high proportion of generalist physician specialties that are engaged in their undergraduate medical education, and the osteopathic philosophy, studies show that students tend to choose practice specialties and practice sites based on their educational experiences. Thus, the commitment of the osteopathic profession to primary care and rural underserved populations is reflected in their educational model and results in DOs choosing generalist specialties and practices in rural and underserved communities at a much higher rate than MDs.

MN: For the participants in these programs, is there a requirement or incentive to work in a rural setting?

BRL: There are no requirements dictating that physicians, once completely trained, from medical school through residency training, practice in rural or underserved communities with a couple of contracted exceptions.

  • Students who participate in tuition support programs such as the National Health Service Corps. These students must agree to serve in these underserved and rural communities for a pre-established number of years. A significant number of physicians remain at these underserved sites after their contract obligations have been met.
  • Students who participate in community loan programs — where communities supply loan repayment and occasionally practice resources to practice in their communities.
  • Many states offer practice and loan repayment incentives if physician locate in rural and underserved communities
  • The Federal government offers federal loan repayment options for physicians who practice in designated Medically Underserved Areas

MN: How are urban and rural communities and medical schools working together to address the needs of the rural community?

BRL: Almost every medical school has some sort of community program for communities that are underserved. In Arkansas, NYIT College of Osteopathic Medicine at Arkansas State University will work closely with 33 community health centers that serve rural and underserved communities to be one of their providers of healthcare as well as sites for teaching our students. We are partnering to place some of our physicians to deliver healthcare in clinics and to use clinics for clinical education sites for our students starting in year two of their medical education. They will also be able to spend time in primary care clerkships in year three. Our student-doctors will work in interdisciplinary teams alongside nurse practitioners, physical therapists, and physician assistants.

MN: Are you seeing an increase in or are you doing any of the following…
a) Providing tax credits to health providers who work in rural and underserved areas?

The state or federal government could do that; however, there is no policy at the federal level.

b) Expanding training programs and number of openings for NP and PAs?

The PA profession is exploding- we are seeing a significant increase in the number of PAs.

c) Expanding graduate medical residencies in primary care?

We currently have 67 new Primary Care residency slots approved within the last 18 months in Arkansas and we anticipate, based on our relationships with small and community-based hospitals in Arkansas that we will be able to establish 200 additional slots within the next two years.

d) Increasing funding for medical loan repayment programs?

I see an increase in the number of states and communities that are pursuing loan repayment programs but I do not see an increase in the level of funding.

 

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