Murray’s bill would help bring physicians to rural communities

The nation isn’t supplying enough primary care physicians to meet future demands, and the need is particularly acute in rural communities.

The Affordable Care Act provided some assistance, but the aid isn’t permanent and it won’t be enough. Last month, U.S. Sen. Patty Murray introduced a bill to address the shortage.

The Community-Based Medical Education Act of 2014 would extend the ACA-funded Teaching Health Center program to 2019. It’s set to expire next year. The program helped the partnership of Providence Health Care, the Empire Health Foundation and Washington State University-Spokane launch the Spokane Teaching Health Center. The goal is to locate the clinic on the Riverpoint campus. The WSU Board of Regents will decide this month whether the university can sell revenue bonds to build the facility.

Initially, six residency slots will be funded, but if Congress enacts an extension, the number of slots could approach 40 by the end of 2019. The location of slots is critical to solving the geographical mismatch between the need for primary care doctors and where they end up working. Research shows they’re more apt to practice where they receive their graduate training.

The numbers in Washington bear this out. Of the approximately 1,600 residency slots in the state, about 1,500 of them are in Western Washington. About 75 are in Spokane. Few of them are in small towns.

A recent Seattle Times article spotlighted the plight in rural areas. Grand Coulee has two family doctors. After working long days, they alternate being on call at night. In Port Angeles, a clinic turns away 250 callers a week.

Doctor shortages are common in rural areas, but the Affordable Care Act has increased the demand for services. Under ACA funding, 28 primary care doctors complete training each year in the state. But it isn’t enough, and that supply will dry up if Congress doesn’t act.

As Dr. Nancy Stevens, director of the Family Medicine Residency Network at the University of Washington, told the Seattle Times, “You really need to create residency slots that are in those areas.”

The Teaching Health Center program recognizes this by financing smaller community-based facilities. Murray’s bill would expand on this approach and partly finance it by slightly lowering Medicare reimbursements at large teaching facilities. Under the bill, the THC program would expire in 2019 and be replaced with permanent funding under Medicare that would annually train 1,500 primary care doctors nationwide. About 34 percent of all physicians are in primary care. The rest are in specialties. But research shows the optimum ratio for better health outcomes would be 50-50.

We can’t finance medical education the same way and hope for different results. Murray’s bill would signal that help is on the way.

– Spokesman Review