doc martens uk ebay a doctor shortage promises to get worse
Jill Kalcich is a family practice physician in the Upper Peninsula’s Keweenaw Peninsula, just a few miles from where she grew up. (courtesy photo)The Center for Michigan Bridge Magazine
Though her choice of medical school took her to the heart of Detroit, Jill Kalcich always knew she would set up practice somewhere a little less crowded.
That’s how the 2002 graduate of the Wayne State University School of Medicine wound up in the Upper Peninsula’s remote Keweenaw Peninsula, where she is the only physician at Keweenaw Holistic Family Medicine. Her clinic office is just a few miles on country roads from where she grew up. In the winter, that can be an adventure.
“Growing up here, I think, was the biggest impact in that decision,” Kalcich said. “When you are practicing in a rural location, you are actually doing more because you don’t have so much access to specialty medicine.
“I have patients all the way from a few weeks old to my oldest, I think, is 98 years old. I see pretty much everything a vast range of any and all health conditions.”
But Michigan needs many more physicians like Kalcich, according to a recent study by the nonprofit Lansing based Citizens Research Council. It found that four rural counties in Michigan Cass, Keweenaw, Lake and Oscoda consistently fall below recommended ratios of primary care physicians to population. Seven other rural counties most in the northern half of the Lower Peninsula fall below suggested ratios in every primary care field it examined except family practice.
In a ranking extracted from 2012 data, the bottom 10 counties in Michigan had ratios of population to primary care physician ranging from 3,095 to 1 in Arenac County north of Bay City to 7,463 to 1 in Cass County in southwest Michigan. All 10 are rural counties. average of 1,342 to 1.
Analysis by the American Academy of Family Physicians found that a “reasonable” ratio of population to primary care physician is 1,200 to 1.
National research suggests that a shortage of primary care physicians can lower the quality of patient care, even as it drives up costs.
“It used to be that one third of medical school graduates were from rural areas. Now it is about one quarter,” said the CRC’s Nicole Bradshaw.
Based on analysis of federal data, Bradshaw estimated that rural Michigan needs another 60 primary care physicians to meet acceptable standards for physician to population ratio.
Bradshaw said the the rural doctor shortage is compounded by the fact that most physicians set up practice within 100 miles of where they complete their residency most likely a hospital in an urban area.
“Unless they have some sort of tie to a community and they always intended to go to a rural area, the research shows that they are unlikely to practice in a rural area,” she said. population lives in rural areas, while only 10 percent of physicians practice there.
At the same time, the percentage of medical students choosing to specialize in primary care the backbone of rural health care has declined significantly. doctors in 1960 were primary care physicians. It is about 25 percent today.
If projections are correct, and unless physician practice trends change, the shortage of rural primary care physicians in Michigan will only worsen as baby boomer doctors continue to retire.
“At the same time that the aging population is demanding more primary care services, an increasing number of physicians are retiring due to age,” the CRC report stated, citing a 2012 survey of Michigan physicians in which 46 percent said they plan to leave medicine within a decade. .
The Center for Health Workforce Studies of the Association of American Medical Colleges projects a shortage in Michigan of 4,400 doctors including both primary care doctors and specialists by 2020.
And it’s more than a matter of inconvenience for residents in rural areas.
Regions with a wide availability of primary care doctors are “positively and consistently associated with improved outcomes, reduced mortality, lower utilization of health care resources, and lower overall costs of care,” according to a 2008 survey of medical literature by the American College of Physicians. Department of Health and Human Services found. It reported an infant mortality rate of 8 deaths per 1,000 births in the most sparsely populated rural counties, compared with 6.2 deaths per 1,000 births in what it categorized as “large fringe metro counties.” The death rate for adults over 65 was 14 percent higher in rural counties.
Phillip Bergquist, director of Health Center Operations for the Michigan Primary Care Association, suspects that disparity has as much to do with rural poverty, social and lifestyle factors as with a shortage of primary care physicians. He oversees 38 federally funded nonprofit Health Care Centers in Michigan, targeted at rural and urban areas that are medically underserved.
This year’s rankings of health outcomes by county in Michigan, compiled by the Robert Wood Johnson Foundation, found a mix of urban and rural counties among the state’s bottom 10.
Wayne and Genessee counties, with their high concentrations of poverty in Detroit and Flint, ranked at the bottom. But seven of the remaining eight at the bottom are rural counties.
Little incentive for rural practice
Bergquist said many rural areas have long struggled with chronic shortages of primary care physicians.
“When they have openings ( for physicians), they tend to stay open longer. That tends to be because providers are not always attracted to living in rural communities. Those communities may not have amenities that are attractive to providers or their families.”
And one rural medical executive says rural communities are up against another big barrier to primary care recruitment: Money.