A panel of speakers at a May 6 congressional briefing described “Strategies to Address Physician Shortages in Rural and Underserved Communities,” a session sponsored by the AAMC with support from the Congressional Academic Medicine Caucus.
Moderated by AAMC Chief Public Policy Officer Atul Grover, M.D., Ph.D., speakers at the briefing included Michelle A. Nuss, M.D., FACP, Campus Associate Dean for Graduate Medical Education and Designated Institutional Official, Georgia Regents University/University of Georgia (GRU/UGA) Medical Partnership Campus; and Connie Berry, M.A., manager, Texas Primary Care Office of the Texas Department of State Health Services.
Dr. Grover gave an overview of the complex factors that influence physicians’ practice locations, noting that while the site of training can play a role in certain circumstances, other factors also drive physicians’ choices, as evidenced by states that retain only a small fraction of trainees. To resolve workforce shortages in rural and underserved communities, he explained, stakeholders should consider a multi-faceted approach that incorporates not only opportunities to facilitate physician training in such areas, but also provides incentives for graduates to practice there.
Dr. Nuss highlighted one existing policy that allows community hospitals to become teaching hospitals and receive Medicare support, despite caps imposed on existing teaching hospitals in 1997. With support from the state, GRU/UGA has worked with hospitals to begin residency programs, particularly in underserved areas of Georgia, though Dr. Nuss described that the initiative has taken considerable time, effort, and resources. She listed challenges to the process, including the high start-up costs and the ability and willingness of medical staff to assume the additional responsibilities associated with operating a high quality training program.
In Texas, policymakers have leveraged a number of federal and state programs that provide incentives for physicians who practice in underserved settings. Ms. Berry talked about how the National Health Service Corps (NHSC) has aided in addressing primary care shortages in both rural and urban underserved areas throughout the state, while a state-sponsored loan repayment program offers additional flexibility to mitigate shortages of specialists too.
Similarly, like other states, Texas participates in the federal Conrad 30 J-1 Visa Waiver Program, which allows international medical graduates to waive the requirement to spend two years in their native country after completing residency in the U.S. if they spend three years working in an underserved area. Many states use the program to help fill deficits not only of primary care physicians, but also a number of other specialties.
Posing the question, “Is it supply or distribution, or both?” Ms. Berry reminded attendees, “In Texas and in many other states, it’s supply and distribution.”
Dr. Grover underscored her observation, saying, “Until we address the national physician shortage, we will continue to have shortages in underserved areas.” As one component of a comprehensive workforce strategy, he encouraged congressional offices to sponsor recently introduced legislation to expand Medicare support for physician training by 15,000 positions over five years (H.R. 2124 and S. 1148) [see Washington Highlights, May 1]. The legislation would allow established teaching hospitals that have reached their limit to expand their training programs with Medicare support immediately, while work to recruit and prepare new teaching programs and other efforts are underway.