Under the Affordable Care Act, Kentucky chose to expand Medicaid eligibility, which means an additional 308,000 Kentuckians will qualify for health care coverage Jan. 1.
But with more patients able to visit primary care physicians comes a problem. There aren’t enough doctors.
Before anyone had even mentioned the Affordable Care Act, Kentucky was short on primary care physicians, particularly in rural areas.
A Kentucky Institute of Medicine report from 2007 found the commonwealth was lacking almost 3,000 physicians, including primary care, to meet the national average.
Dr. Emery Wilson is the director of University of Kentucky’s Office of Health Research and Development. He said Kentucky still has a shortage and faces some new obstacles in addition to expanded Medicaid under the Affordable Care Act.
“The other thing that lends itself to an increasing need for physicians is the aging population and the more chronic disease that people have and that tends to be worse in rural areas too,” he said.
In a 2012 health care report, a Foundation for a Healthy Kentucky panel of health care professionals said the biggest issue in rural communities was the provider shortage. And a May 2013 Deloitte and Kentucky Health Benefit Exchange report found the neediest area for primary care physicians was a western eight county region stretching from Graves to Allen.
Why Kentucky and other rural areas are short on doctors is a complicated answer. It’s part young doctors’ lifestyle and desire for urban living, part struggles for reimbursement and simply not enough rural medical training programs.
Madisonville family physician Dr. William Crump with the University of Louisville directs one such program. He said the influx of specialty doctors is part of the primary care shortage.
“If you look at the countries around the world that provide really top quality care really at quite a bit less cost than we do in the United States it’s about 70 percent primary care and 30 percent subspecialty,” Crump said. “That percentage seems to be the magic ratio that gives the best care. In the United States we’re reversed.”
Crump hopes to nudge Kentucky’s ratio forward by training medical students at the rural family practice residency.
Dr. Alisa Marzec was one of Crump’s residents. The thin woman with kind blue eyes and long brunette hair sips coffee in her new office at Baptist Health’s Hopkinsville location. She’s waiting for her patients to arrive as the television plays in the waiting room. In one fell swoop Marzec explains a large aspect of the shortage.
“In medical school most of my colleagues decided they wanted to do a specialty,” she said. “Well, specialists can’t survive in small towns--you need the primary care--and because so many students in the medical school want to go to specialty there aren’t as many primary care residencies. Because there’s fewer primary care residencies, there become fewer primary care physicians which means fewer physicians in the rural settings.”
Crump said most physicians interested in serving rural communities come from a rural background, and that those who choose that path are important to keeping the commonwealth healthy. But Dr. Emery Wilson at UK has had access to medical students’ questionnaires and found some troubling news about students outside the commonwealth.
“Almost no one from those other states say that they plan to practice in Kentucky,” he said. “If we want more physicians in the state we’re going to have to train them ourselves because other states are not going to train them for us.”
The Rural Physician Leadership Program aimed to do just that in Murray, and was initially set to begin in 2014. RPLP was planned to be a partnership between Murray State, the Murray-Calloway County Hospital and the UK College of Medicine. The program would host 10 students in their third and fourth years of clinical study as they rotated between hospitals throughout western Kentucky.
But MCCH Vice President of Institutional Advancement Keith Travis said the program didn’t come to fruition.
“Long story short is that Dr. Wilson retired from UK as dean, then UK got a new hospital president and a new university president, and Murray State got a new president,” he said. “And there’s been so much change and everything on the program right now that the program is on hold.”
Travis said a Murray physician is still working on bringing something like the RPLP to the region, but admits there is still much work to be done.
Meanwhile, Alisa Marzec continues to develop her practice in Hopkinsville, serving people who sometimes drive from counties over just to see her. She said her first week her schedule was full and that she continues to stay busy.