It’s a national health care crisis. There just aren’t enough doctors in our country. The shortage has hit rural America especially hard, but there may be some solutions. NBC’s chief medical editor Dr. Nancy Snyderman reports.
Tucked among the cornfields, windmills and water towers of Littlefield, in west Texas, Dr. Isabel Molina treats one patient after the next at Lamb Healthcare Center.
Littlefield is a small, dusty town of about 6,500 people, but Molina’s two-doctor practice draws from a much larger area. She and her partner serve a total population of about 15,000, she estimates. To keep up with her patient load, Molina regularly works 13-hour days without stopping to eat.
“I usually eat breakfast over charts. I usually eat lunch over charts while I call patients back and take care of my dictations,” says Molina, 38. “I do love what I do, but it is getting a lot harder to do this.”
A nationwide doctor shortage is expected to worsen over the next decade, according to the Association of American Medical Colleges. Medical schools, like Texas Tech University Health Sciences Center are coming up with innovative ways to get young doctors practicing with fewer years in medical school. Dr. Steven Berk, TTUHSC Dean on the crisis and their efforts to help.
Molina is just one of thousands of primary care doctors nationwide working in an area designated as having too few health professions to meet the needs of the population.
The Association of American Medical Colleges (AAMC) estimates that there is a shortage of up to 20,000 physicians and that the deficit will grow to 100,000 physicians in the next decade. An aging population – and an aging population of physicians themselves – will make matters worse as health needs become more severe and as doctors retire without enough new ones to replace them. And, millions more Americans will rely on our existing physicians when the Affordable Care Act fully kicks in next year.
“We are very concerned that we’re going to hand insurance cards to 30 million people and we won’t have the doctors to treat them,” says Dr. Atul Grover, the chief public policy officer at the AAMC.
West Texas is one pocket of the country where entire counties lack even a single health care provider. The dire need inspired an innovative program at Texas Tech University Health Sciences Center in Lubbock, Texas.
“We felt at Texas Tech that it was very important to help solve the primary care crisis as best we could and one of the ways of doing that was to try to make sure we get enough students into primary care and into family medicine,” says Dr. Steven Berk, the dean of the School of Medicine at Texas Tech University Health Sciences Center.
From that concern, the Family Medicine Accelerated Track (FMAT) was born at Texas Tech. The program teaches the competencies of four years of medical school in only three years and offers a scholarship to all students in their first year.
Keeley Ewing-Bramblett is a third-year medical student at Texas Tech who grew up in the rural, one-physician town of Post, Texas, and saw firsthand how overloaded the town’s only doctor was.
“I really just want to go back to a place where I know I’m going to be making an impact and where I’m going to get to see kind of the fruits of that impact,” says Ewing-Bramblett, 24. She signed up for the FMAT program the day she heard about it, and hasn’t looked back.
Medical students nationwide are struggling to find residency positions – a crucial stage in their process of becoming a doctor. But, a unique program at Texas Tech University Health Sciences Center School of Medicine guarantees residency spots for Keeley Ewing-Bramblett and her fellow students. It will allow her to stay in a rural area where, “I know I’m going to be making an impact.”
“When they offered an accelerated track where I could get out and be doing what I love essentially a year sooner and also for half the amount of debt that would have otherwise been incurred, for me it was kind of a no-brainer,” recalls Ewing-Bramblett.
To curb the physician shortage, medical schools across the country have boosted their enrollment by 16.6 percent since 2000. Five-thousand more students are expected to graduate per year by 2019, according to the AAMC.
But just graduating more students won’t reverse the physician shortage.
There has been a bottleneck to getting more young doctors into residency programs: the stage in medical training that follows graduation from medical school and takes place under the supervision of licensed physicians. The number of federally funded residencies has been frozen since 1997 when Congress passed the Balanced Budget Act.
“A lot of the benefit of increasing those class sizes and building those new medical schools – a lot of those benefits won’t be realized unless there’s additional residency positions,” admits Berk.
Of almost 22,000 U.S. medical school graduates who wanted to be “matched” to a residency position this year, 1,600 applicants did not find one, according to the National Resident Matching Program that places residents.
That’s one more reason why lawmakers are stepping in. Congressman Aaron Schock (R-IL) and Congresswoman Allyson Schwartz (D-PA) introduced the “Training Tomorrow’s Doctors Today Act” in March that would create 15,000 new Graduate Medical Education slots over the next five years.
In an interview, Schock stressed that, “We know that a crisis is coming where there are more and more Americans who need doctors that are going to go without if we don’t get them trained and in the field.”
Even if the bill passes – no easy task in an era of squeezed budgets – there is no guarantee that new doctors will practice in the areas where they are needed most.
“Physicians cluster in urban centers where they can work with each other efficiently and leave the rural areas and some other areas underserved in the process,” explained Dr. Richard “Buz” Cooper, director of the New York Institute of Technology’s Center for the Future of the Healthcare Workforce.
Back in Littlefield, Molina bounds from one appointment to the next. “When you’re this short-staffed, it becomes something that is at the cost of everything else. Missing things with my kid, missing things with my family,” she admits.
As she leaves one exam room, files the necessary stack of papers and steps into another room to asses a patient, , she smiles all the while. “Once I actually have help, I think then I’ll be able to relax and see what a real life feels like again.”
Dr. Michael Johns, a professor in the Schools of Medicine and Public Health at Emory University, says it will take wider reform to get doctors the help they need. “Just having more doctors is not going to fix this.” he says. “For one, we need a team-based approach that will get nurses, and other members of the healthcare team more involved with more responsibility.”
And, while the Family Medicine Accelerated Track will graduate more family care doctors, it does nothing to increase the number of specialty physicians nationwide.
“What everyone is missing is that a little over half of the shortage is in specialty medicine,” argues Johns. “The battle shouldn’t be about having a 30-to-70 ratio of specialists to primary care doctors, it should be about how we have a shortage of both.”
The slow pace of reform is frustrating for medical students like Ewing-Bramblett who chose primary care medicine because her mother suffers from chronic illness and a primary care physician made an outstanding difference in her care.
“It hurts me on a few levels,” said Ewing-Bramblett. “There’s just no way that you can establish the type of relationship with your patients that’s going to really foster their care like I experienced with my mom. There’s no way you can do that in the 10 minutes that you have to see each patient.”
For now, all she can think to do is hold on to her determined spirit. She knows what to expect: the long hours, waiting rooms packed with patients, even personal sacrifices.
“There’s really no question about where I want to go,” she says. “I’m going to be making a difference in at least one small community.”