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How is the physician shortage impacting rural Missourians?

By Kyle Murphy, PhD

The shortage of primary care physician in Missouri is leading to disparities in healthcare between rural and urban patient population and forcing the state to make important changes to its primary care system, according to a special report by the Missouri Hospital Association. “It has never been more urgent for Missouri to show a commitment to the primary care shortage. The future economic stability and health status of Missourians depends on it,” the MHA claims.

So how bad is the situation in Missouri? According to Missouri Foundation for Health, a vast majority of Missourians (80%) live in a Health Resources and Services Administration (HPSA) in which the physician to population ratio is 1:3,500.

“Increasing the number of primary care clinicians is important; so is the location of the clinician’s practice,” state the authors of the report. “The distribution of physicians can result in large primary care ‘deserts’ in areas of rural Missouri and underserved areas of urban Missouri.”

Whereas the number of licensed physicians in metro Missouri has increased over the past three years — from 12,379 in 2011 to 13,446 in 2014 — rural Missouri has seen a decrease from 1,646 to 1,402. What has not improved for either locale is the average age of physicians which is in the mid-50s with more than 60 percent of all licensed physicians at age 50 or older.

In looking for solutions to the growing disparities in urban and rural healthcare, the MHA report identifies several options, with the first being a reallocation of resources and responsibilities:

Changing the delivery system may be the solution to the primary care physician issue because changes in the reallocation of clinical responsibilities could greatly increase physicians’ capacity to meet patient demand. Reallocating these resources could significantly increase primary care practices’ ability to meet patient needs in preventive, chronic and acute care.

Another option centers on the shifting of delivery models to allow non-physician clinicians to fill in the gaps left by a physician shortage:

As previously noted, most medical students do not choose primary care as their specialty. However, the majority of nurse practitioners are trained in primary care. Nurse practitioners will be an important resource for future primary care needs. Researchers estimate that 60 percent of preventive care services can be performed by non-diagnosing health professionals.

Similarly, the use of assistant physician practice collaborative arrangements could empower these clinicians to provide primary care services in medically underserved areas in Missouri.

The MHA is also looking to actions taken by other states such as the training of community health workers who can provide health information, resources, and services in rural communities.

With the Affordable Care Act (ACA) set to increase the number of insured individuals, its effect could be placing further stress and strain on primary care physicians whose numbers are already limited.

Read the full report here.

 

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