Doctor shortage in coming years will hit rural areas mostConcern about a shortage of doctors in rural areas is nothing new. But a combination of factors — the aging of doctors and their patients, and the Affordable Care Act’s requirements for health insurance coverage — has the health-care system bracing for greater challenges in the near future.
By: John Lundy, Duluth News Tribune
Concern about a shortage of doctors in rural areas is nothing new.
It’s why the University of Minnesota Medical School set up its Rural Physician Associate Program for third-year students in 1971, why the medical school established its Duluth campus in 1972, and why the Duluth Family Medical Residency Program was set up in 1977.
But a combination of factors — the aging of doctors and their patients, and the Affordable Care Act’s requirements for health insurance coverage — has the health-care system bracing for greater challenges in the near future.
“We can’t get enough people coming out of our residency programs to come even close to meeting the needs,” said Terry Hill, executive director of the Duluth-based National Rural Health Resource Center.
The Association of American Medical Colleges forecasts a national shortage of 62,900 physicians by 2015, including 29,800 in primary care — internal medicine, family medicine or pediatrics. By 2025, it predicts, the numbers will grow to 130,600 physicians, including 65,800 in primary care.
Mark Schoenbaum and Edward Van Cleave of the Minnesota Department of Health used the Association of American Medical Colleges numbers as one of several sources when considering future shortages in the state. In an article in the February issue of Minnesota Medicine, the trade publication of the Minnesota Medical Association, they predicted a shortage of between 1,000 and 3,000 primary-care providers in the state between 2020 and 2025. The demand for all specialties is expected to be as high as 14,000.
Dr. Ray Christensen, associate dean for rural health on the Duluth campus of the University of Minnesota Medical School, cautioned that numbers can be overstated. The number of physicians a clinic states it would like to have might be higher than the number it actually would hire, he explained.
The numbers may be uncertain, but everyone agrees there is a shortage, it’s going to get worse and it’s worse in rural areas than in cities and suburbs.
“The recruiting challenges for most health-care occupations are more daunting in rural areas,” Schoenbaum said in an interview.
Christensen said he thinks between 100 and 300 physicians “could be absorbed very nicely” in rural Minnesota today.
At least three factors are exacerbating the shortage, experts say:
Susan Brower, Minnesota state demographer, predicts the number of people ages 65 and over will grow by 466,000 between 2010 and 2025, from 13 percent of the total state population in 2010 to 19 percent in 2025.
Not only is the baby boom generation entering retirement years, Christensen said, they’re poised to live longer than previous generations. But it also has been a relatively healthy generation. And a lot depends, he said, on how much medical care they choose to demand.
“It depends on what you guys think,” he told a baby boomer. “If you say: Everybody dies, and I gotta make some reasonable decisions … and you’ve chosen that there are times when you would just as soon not explore all that medicine has to offer, then I hope that will bring (the demand) down.”
In general, though, an aging population requires more care. The Institute of Medicine, the health arm of the National Academies of Science, says more than three-quarters of adults older than 65 have at least one chronic medical condition that requires ongoing care and management.
More than one-third of primary-care doctors in Minnesota are 55 or older, according to the U.S. Agency for Healthcare Research and Quality.
The aging of the medical work force is particularly noteworthy in rural areas, said Sandra Barkley, director of clinic for St. Luke’s hospital.
“In some of those smaller areas, all they have are family docs, and a big chunk of them are over 55 years old,” she said. “And so when those folks retire it’s going to be really hard to find folks to take their place.”
Provisions of the Affordable Care Act will add 29 million to the ranks of Americans with health insurance, predicted health analysts Elbert S. Huang and Kenneth Finegold, writing in the March edition of the publication Health Affairs. That will result in 25.7 million additional primary-care visits per year, they predicted.
MNsure, the agency formed to administer the online insurance marketplace in Minnesota, predicts the state will have 1.3 million more people with health insurance by 2016.
No one is sure exactly what the effect will be.
“I do know that there’s likely people out there who don’t seek care,” Barkley said. “When they have insurance, they might. I don’t think any of us know how big that pool will be. But it is a concern.”