By Katy Stewart and Kelly Mae Ross
The physician population in the Rockbridge area is getting old, and recruiting new doctors to the region can be hard.
At Carilion Stonewall Jackson Hospital, the only hospital in the county, many of the doctors are at least 60, says Bob Capito, the hospital’s utilization review coordinator. With those doctors nearing the end of their careers, recruiting new ones to replace them is key.
But young doctors consider many professional and personal factors when deciding on a place to practice. And for many medical students, rural areas don’t rank high on their lists.
In fact, in 2012, only 2.9 percent of first-year medical students said they planned to practice in small towns or rural areas after graduation, according to the Association of American Medical Colleges.
Ashley Gerrish is a third-year medical student at Virginia Tech Carilion School of Medicine in Roanoke. She wants to be a surgeon and will start applying for residencies in the fall.
“I’m really only looking at places close to family,” she said. For Gerrish and her husband, Andrew, that means the region between North Carolina and Pennsylvania. She said she would apply to about 30 programs in the region, but that won’t include the Rockbridge area.
Most surgery residencies are in urban areas, Gerrish said, and there are no surgery residencies here. So the Virginia programs she’s applying to are in such cities as Norfolk, Richmond and Washington, D.C.
Andrew Gerrish, a lawyer, will take the bar exam wherever they move. She said they will consider what’s best for both their careers when making their final decision.
“For me, it’s a joint decision,” she said.
Sidney Watson, a professor at the Saint Louis University School of Law’s Center for Health Law Studies, said there are four main reasons that recruiting physicians to rural areas is challenging.
First, rural areas tend to have more uninsured people or people covered by Medicare and Medicaid. So hospitals make less money and doctors’ salaries are lower. Public insurance programs don’t reimburse hospitals for care as generously as private insurance companies often do.
In fiscal year 2011, 42 percent of Stonewall Jackson’s billing charges were for services provided to Medicare patients, and 7 percent were for Medicaid patients, according to the hospital’s financial statements.
Joining the Carilion Clinic, which operates eight nonprofit hospitals in Virginia and West Virginia, has enabled Stonewall Jackson to pay its doctors a little more than it could before, Capito said. But young doctors also have to think about repaying their medical school loans, and even a slightly higher small-town medical salary might not be enough to pay the bills.
Second, practicing in a rural area with a limited number of health care providers often means longer hours, because when emergencies arise, there are fewer people who can be called to help.
“If you’re the only doctor in town, you can’t ever take a break,” Watson said.
Third, planning for the future with a significant other can play a role. Watson said that if a medical student has a partner and wants to continue the relationship after graduation the couple might be more likely to find job opportunities in urban areas. Gerrish and her husband are an example of that.
Fourth, Watson said that people often relocate to communities similar in size to the places where they grew up.
There are clear data that show that primary care physicians in the Rockbridge area are overburdened, and there aren’t enough of them.
The national benchmark for the number of persons per primary care physician in an area is 631:1, as of 2012.
In Lexington, there is one primary care physician for every 2,294 people.
In Buena Vista, there is one primary care physician for every 3,130 people.
In Rockbridge County, the number is much closer to the national benchmark, with one primary care physician for every 650 people.
Those figures are cited in the Rockbridge Area Community Health Needs Assessment, an extensive survey spearheaded by the Rockbridge Area Health Center in 2012.
For the purposes of the calculation, the U.S. Health Resources and Services Administration considered more specific criteria than just the number of doctors listed in the phone book. The calculation shows full-time equivalent primary care physicians, so part-time practitioners count as less than one doctor. That includes practitioners who are semi-retired.
But the Rockbridge area is not the only community grappling with the issue.
In 2006, though 20 percent of Americans lived in rural areas, only 9 percent of physicians practiced in those communities, according to an article Watson wrote in 2010.
The federal government has taken steps to address those shortages.
The National Health Service Corps program was founded in 1972 to place more health care providers in the areas that need the most help. The program offers scholarships and loan repayment to medical students willing to practice a minimum of two years in areas that need doctors.
According to the Health Resources and Services Administration, there are nearly 10,000 corps members providing care to more than 10.4 million people today. That’s up from 3,600 corps members in 2008.
And a majority of medical professionals sponsored by the program stay in the rural areas in which they were placed even after they complete their corps service obligation.
According to the Health Resources and Services Administration, 55 percent of clinicians stay at least 10 years after they fulfill their service obligations.
The National Health Service Corps will expand under the Affordable Care Act, said Timothy Jost, a professor at Washington and Lee University School of Law.
That expansion will come in the form of increased funding, and it has already begun.
A provision in the Affordable Care Act that began in the 2011 budget year will give $1.5 billion more to the National Health Service Corps over five years. The program received $290 million of the increased funding the first year.
Prior to the Affordable Care Act, the National Health Service Corps received a $300 million increase in funding as part of the American Recovery and Reinvestment Act — the stimulus — over the course of the 2009-2011 budget years.
All that additional funding means that the program can afford to both hire more doctors and pay them more. The legislation will allow the National Health Service Corps to offer those new doctors loan-repayment packages of up to $60,000 for two years of service. The previous cap was $50,000.
“The [Affordable Care Act] was largely drafted by senators from rural states, and they take care of their own,” said Jost. “So, yes, there are benefits in the legislation for rural areas.”