Fix the primary care shortage before it’s a crisis

Georgia’s primary care physician shortage is dire and only getting worse.

The state has only 200 physicians for every 100,000 people. That ratio makes it 39th in the nation. (Some states have ratios as high as 350 per 100,000.)

Denise Kornegay
Denise Kornegay

This shortage is a direct result of the Congressional Balanced Budget Act of 1997, which froze Medicare-funded graduate medical education residency numbers and locations across the country.

Since that time, Georgia’s population has grown nearly 77 percent, while national population growth was 36 percent, and several Northern states showed only minimal population growth or none at all.

So even as our state population surges, our Medicare-funded slots remain capped at 20.8 residents per 100,000 population, which cripples our efforts to produce more primary care physicians.

Our shortage is such that Georgia would need 1,450 additional residency positions to match the national average and 315 additional residency positions to match the Southeast average.

It is critically important that aggressive action be taken sooner rather than later to retain and expand our primary care workforce. To that end, the Georgia Statewide Area Health Education Center’s (AHEC) Primary Care Summit has been held annually since 2008 and brings together more than 200 stakeholders from around Georgia.

Matt Caseman
Matt Caseman

The focus of the summit is to determine the best and most practical recommendations to address Georgia’s primary care shortage across all phases of the medical education pipeline. Through the efforts and hard work of participants, an ambitious agenda has been developed for the 2014 legislative session.

Although Georgia is known for having five great medical schools with many talented students, the state is too often not retaining these individuals once they graduate. They wind up working as doctors in other states.

Research indicates that medical professionals tend to stay within 30 to 60 miles of where they received most of their training. But many Georgia medical school graduates are not choosing to complete their residency training here. In 2011, only 15.8 percent of Georgia’s first-year residency slots were filled by Georgia medical school graduates.

The 2013 Primary Care Summit recommendations address challenges in educating our existing medical students by advocating tax credits for primary care community-based faculty members who host 3rd- and 4th-year Georgia medical students, physician assistant students, and nurse practitioner students in their practices for required training.

It is imperative that the training of these students be secured in communities across the state, as these three disciplines form the core primary care workforce. Estimates show such a tax credit would cause a minuscule loss  of revenue to the state, but would have a major impact on the primary care workforce available to our rural citizens. Additionally, funding for student housing and travel must be increased to reflect the significant growth in our medical school enrollments.

We also must significantly increase the total number of Georgia Graduate Medical Education slots in primary care disciplines. We, therefore, strongly support the Board of Regents request for $3.2 million in new funds for the creation of new residency slots in Georgia, with a goal of funding an eventual 400 new residency slots in the state. These slots must be supported financially, and recruitment for all residency programs in the state needs to be heightened, if we are to retain Georgia medical school graduates.

We must also increase both the number and total monetary amount of loan forgiveness awards available through the Georgia Board for Physician Workforce. This board has submitted budget requests to the governor to allow for such increases in these critical awards. Loan forgiveness is offered to those who complete Georgia residency programs and are willing to work in smaller communities in Georgia. The funds go toward covering their educational loan debts on a year-by-year basis.
This is a vital recruitment and retention tool to keep physicians in the state.

While the recommendations from the Primary Care Summit focus largely on state-level solutions, there is recognition that Georgia’s U.S. congressional delegation needs to push for action at the federal level.

The national cap on residency slots must be expanded and adjusted to allow states with significant population growth the ability to open new slots. Payment differentials between primary care disciplines and specialty practices must be addressed to incentivize medical students to choose primary care. And the medical education debt (estimated to be $200,000 per student by 2015) must be addressed.

Studies show rural Georgians are less healthy than those living in urban areas. They are more likely to have insufficient insurance or none at all. There’s more diabetes, obesity, heart disease and cancer among rural populations, and people living in the countryside are more likely than those living in the city to die in traumatic accidents. Primary care providers are desperately needed to increase the quality of life and longevity of rural and medically underserved populations.

With the implementation of the Affordable Care Act, more Georgians are going to have financial access to health care through programs that expand insurance coverage. However, if there are no physicians practicing in our rural communities, many of these people will have no real, physical access to the care they have signed up for. We have 159 counties in our state. Of these, 6 are currently without a family physician, 31 are without a general internist, 63 are without a pediatrician, 79 are without an OB/GYN, and 66 are without a general surgeon.

With increasing financial access adding to the numbers seeking health care, our already thin primary care workforce will be stretched well beyond its limited capacity, unless there is immediate and dramatic action. Next year is too late. Actions must be taken immediately and aggressively pursued if Georgia is going to have the workforce it needs to provide for its citizens now and in the near future.

Denise Kornegay is the executive director of the Statewide Area Health Education Network, an associate professor of Family Medicine at Medical College of Georgia / Georgia Regents University, and immediate past president of the Georgia Rural Health Association.

Matt Caseman is the executive director of the Georgia Rural Health Association.