Tuesday, September 16th, 2014

The Obameter

Attract more doctors to rural areas

Obama will "attract more doctors to rural areas."


Subjects: Health Care, Workers

Updates

Obama administration initiatives add doctors in rural areas

Barack Obama ran for office in 2008 promising to invest in rural areas, which face unique health care challenges — including doctor shortages. He promised in his Blueprint for Change to "attract more doctors to rural areas."

And though there's more to do, he's largely followed through, experts say.

"You would have to go back a ways before you'd have another administration that was as favorable for getting folks into rural locations,” said Mark Doescher, a physician and researcher at the University of Oklahoma Health Sciences Center and former director of the University of Washington's Center for Health Workforce Studies.

The Obama administration significantly boosted support for the National Health Service Corps, which offers scholarships and loan repayment to doctors in exchange for working in underserved areas — including an extra $300 million from the stimulus.

That two-year funding from the American Recovery and Reinvestment Act roughly doubled the number of doctors in the loan repayment program to 4,544, more than 40 percent of whom serve in rural areas, according to a study in the Journal of the American Board of Family Medicine.

In August 2011, the administration expanded eligibility for the loan repayment program to "critical access hospitals,” which have 25 beds or fewer.

Meanwhile, the administration has promoted residency opportunities in rural areas, reallocating residency slots, investing in the Rural Training Track program, and spending $230 million on a five-year initiative to put more primary care residents in community settings, including rural areas.

Once primary care physicians train in rural areas, the goal is to keep them there.

A 10 percent increase in Medicare payment rates for primary care physicians through 2016 was intended to help, though some physicians say the bonuses aren't big enough to have much impact — and need to be made permanent.

These steps aren't enough to solve rural workforce shortages, but they do "attract more doctors to rural areas.” We rate this Promise Kept.

Sources:

Government Printing Office,The Patient Protection and Affordable Care Act, March 23, 2010

National Rural Health Association, "What's Different about Rural Health Care?" accessed Nov. 29, 2012

Southwest Rural Health Research Center, "Rural Healthy People 2010," 2003

White House Rural Council, "Policy initiatives," accessed Nov. 28, 2012

Health and Human Services Secretary Kathleen Sebelius, speech to the National Rural Health Association Policy Institute, Jan. 30, 2012

Email interview with Mark Doescher, professor, University of Oklahoma Health Sciences Center, Dec. 4, 2012

Email interview with Keith Mueller, professor, University of Iowa College of Public Health, Dec. 4, 2012

The Journal of the American Board of Family Medicine, "Growth and changes in the National Health Service Corps (NHSC) workforce with the American Recovery and Reinvestment Act," Sept.-Oct. 2012

National Health Service Corps, "About the NHSC,” accessed Dec. 3, 2012

Rural Assistance Center, "About the Rural Training Track Technical Assistance Program,” accessed Dec. 5, 2012

Health Resources and Services Administration, "Teaching Health Center Graduate Medical Education (THCGME),” accessed Dec. 5, 2012

American Academy of Family Physicians, "Health Care Reform Law Calls for Reassigning Residency Slots to Benefit Primary Care,” Dec. 1, 2010

American Medical News, "Medicare's bet on primary care,” May 28, 2012

Email interview with Erik Johnston, associate legislative director, National Association of Counties, Nov. 30. 2012

Health care reform addresses rural doctor shortage

President Barack Obama promised to attract more doctors to rural areas, and that goal is included in health care legislation under consideration in Congress.

A bill approved by the Senate specifically addresses doctors in rural areas. The bill would redistribute funding for training positions for doctors, assigning open positions to primary care and to underserved and rural areas. It would also provide grants to states for recruiting doctors to rural areas.

The Senate and the House have to reconcile their competing versions of the health care overhaul and vote on final passage. So we'll have to see if the provisions for rural doctors make it into the final bill. For now, we rate this promise In the Works.

Sources:

Thomas, Patient Protection and Affordable Care Act (Senate health care overhaul), accessed Dec. 29, 2009

The Washington Post, The only doctor in town , Dec. 5, 2009

The Kaiser Family Foundation, Side-by-side comparison of the House and Senate Leadership Bills , accessed Dec. 29, 2009