Ambitious, educated and in debt – the world of Dr. John Gallagher was New York City.
“I got a national scholarship to pay three years of medical school debt and I had to work in an underserved area,” said Gallagher of Sharon.
Thirty-three years later, Gallagher remains in western Pennsylvania.
He watches COVID-19 creep into rural America and other regions where long-standing medical shortages are now being exacerbated by the pandemic. Countless numbers of independent GPs are closing, he said.
“Some of these independent physicians – like any other small business – hang by a thread,” said Gallagher, chairman of the board of the Pennsylvania Medical Society. “We don’t have any numbers yet. I know at least three local doctors who are packing everything up. “
For decades, medical experts have warned US executives and policymakers against a “maldistribution” of active doctors.
In March 2020, the Kaiser Family Foundation commissioned a report on practicing physicians, broken down by specialty and the US state in which they are licensed to practice. The report counted all “currently active allopathic physicians (MDs) and osteopathic physicians (DOs)” together.
In Massachusetts, there were 30 doctors for every 10,000 people in the state.
Wyoming had nine.
There were 2.4 emergency doctors for every 10,000 residents in New York State.
Idaho had less than one.
“If there was one place in this country where this virus was going to hit hard, New York City was best prepared,” said Jennifer Tolbert, KFF state director for health reform. “(New York) had the most hospital beds and more doctors.”
“The real concern here is that this virus is spreading in a significant way to rural areas,” Tolbert continued. “There will simply be no infrastructure, be it the hospitals or the doctors.”
In Pennsylvania, the US Department of Health estimates that 62 out of 67 counties have “health worker shortages” in primary care. Case numbers and deaths are rising there and elsewhere across the state. Only five counties – Berks, Berks, Cumberland, Lehigh, and Montgomery – are said to have enough family doctors.
The Hospital and Healthsystem Association of Pennsylvania has overseen the staffing of medical centers in the state for years.
“I don’t think you’ll find a single full-staffed hospital in Pennsylvania. Last year we had three hospitals that closed, ”said Robert G. Shipp, vice president of population health and clinical affairs for the association. One of them was the Ellwood City Medical Center.
The Pennsylvania Department of Health recognizes the growing program and said it has taken steps in response.
“The Department of Health is providing loan repayment opportunities as an incentive to recruit and retain primary care physicians willing to serve underserved Pennsylvania residents and commit to practicing in a federally designated health care professional area,” said Nate Wardle. Agency spokesman.
“We know these areas exist in both urban and rural areas. Our loan repayment options exist to help primary care physicians who are ready to serve in specific areas. “
So how did we get here? Experts point out more than a dozen factors.
Medical school is expensive.
Graduates from doctors with medical debt can make more money in more affluent communities.
Doctors can make more money by going into a specialty as opposed to a general practitioner practice.
Government regulations and insurance claims paperwork have driven some doctors into networks or health systems that exist in certain locations.
Networks can get doctors to sign agreements preventing them from competing with the network if they leave that network. For example, a doctor who leaves a network can be barred from working in a certain area of the country if this is covered by his previous employer.
The world population is also growing faster than medical schools can train new doctors. Forecasts are bleak.
“The population is growing and the number of doctors is not growing,” said Tony Stajduhar, president of Jackson Physician Search in Fulton County, Georgia.
“At the moment it is practically impossible for us to ever make up for the shortage,” added Stajduhar.
The problem is so big that nobody wants to tackle it, he said. “It will be so long before we get close to this gap,” said Stajduhar. “It’s a crash course.”
Jackson Physician Search data also reveals the monetary appeal of metropolitan medicine. On average, American doctors in urban areas make $ 16,000 more annually.
In New York, doctors in major cities make $ 21,253 more than in the more rural parts of the Empire State.
In light of COVID-19, the shortage of doctors in emergency medicine and other intensive care units is classified as “particularly urgent,” said David J. Skorton, president of the Association of American Medical Colleges. In a June 26 report, Skorton said hospitals in hard-hit areas are expanding the roles of licensed nurses, graduating students early from medical school, and pulling doctors out of retirement.
“We have nine medical schools in Pennsylvania. We train a lot of doctors, but those doctors don’t all stay here, ”Shipp said.
“Pennsylvania has high medical malpractice insurance rates,” he continued. “We’re in the top 10 states with medical malpractice lawsuits. That could be a reason. “
Healthcare providers are using technology to reduce the time doctors spend on notes and other paperwork.
Lending programs could encourage more relocations in the state, Shipp said. Telemedicine has also risen sharply since the pandemic, so doctors can schedule more patients.
In the absence of active doctors, many cities are increasingly relying on nurses and other trained caregivers, Gallagher said.
About half of all US states have licensed nurses to diagnose and treat patients, and to prescribe drugs and controlled substances.
Pennsylvania law requires nurses to have a collaboration agreement with a doctor, a signed document that works like a business contract. In response to the pandemic, some restrictions on the work of nurses were temporarily lifted on March 20.
“That may be one way of dealing with this situation,” Shipp said. Schools in the state could develop nurse training programs, although there is no guarantee that trained nurses in rural areas will work without doctors.
“We have tried to bring more LPNs to rural areas, but they are also staying in the cities,” said Gallagher. “We have large swathes of medical shortage in northwest Pennsylvania from Crawford County to Erie and all the way to McKean. We have large parts of central Pennsylvania where you have some districts that have a doctor, if any.
“We will see people transported 90 miles to attend to COVID,” Gallagher said. “It really is like an atomic bomb.”