Letter to Rep. Gibbons Supporting Physician Incentivies to Serve Rural America Act

The Honorable James Gibbons
100 Cannon House Office Building
Washington, DC 20515

Dear Representative Gibbons:

On behalf of the 94,000 members of the American Academy of Family Physicians, I am pleased to express our support for legislation you have sponsored which would enable physicians who practice in rural America to be eligible for a one-time, $20,000 tax credit. This legislation is intended to encourage physicians to engage in practice opportunities that serve rural communities. This tax credit for rural physicians, which could be extended over several years, but could not exceed $20,000, would be made available to physicians who furnish at least 250 Medicare patient visits per year in rural areas in the immediate past two-year period.

Access to high quality health care services for rural Americans continues to be dependent upon an adequate supply of rural physicians. Despite efforts to abate rural shortages, there continues to be a scarcity of physicians for rural areas. Studies, whether they are based on the demand to hire physicians by hospitals/physician groups or on the number of individuals per physician in a rural area, all indicate a need for additional physicians in rural areas.

Family physicians comprise just 20 percent of the U.S. outpatient physician work force, yet they account for about 199 million of the approximately 822 million visits that Americans make to their physicians each year. In rural areas, an even greater proportion of these visits are to family physician offices. Possessing a broad range of skills, family physicians provide comprehensive and irreplaceable care to small rural communities. A recent study from the Robert Graham Center for Policy Studies in Family Practice and Primary Care indicated that, if family physicians were removed from the 1,548 rural U.S. counties that are not Primary Care Health Personnel Shortage Areas (PCHPSAs), 67.8 percent of those counties would become PCHPSAs.

In addition, a 2001 study conduced by the Center for Health Policy Research, Center for Health Sciences at Oklahoma State University determined that licensed physicians are one of the most powerful economic engines for a local economy. The total economic impact that results from the presence of one family physician in a local community exceeds $1.1 million annually.

Despite the enormous contributions, both clinically and economically, that family physicians make to rural populations, and despite a reported surplus of physicians in the United States, the country's rural areas have been medically underserved for decades. While about 20 percent of the U.S. population lives in rural areas, rural physicians comprise only about 10 percent of the total number of working physicians

in the country. In rural communities of fewer than 10,000 inhabitants, there are about 90 physicians per 100,000 persons. In major metropolitan areas, the ratio is about 300 physicians to every 100,000 persons. In rural cities with populations of more than 10,000 persons, there are about 170 physicians per 100,000 persons. Sparse population, extreme poverty, high proportions of racial and ethnic minorities, and lack of physical and cultural amenities characterize rural communities most likely to suffer from a insufficient number of physicians. This persistent, intractable shortage of physicians in rural communities means that many struggle continuously to recruit and retain physicians. Assistance in these recruitment and retention efforts is indicated.

The Physician Incentives to Serve Rural America Act, while not the total answer for small rural and underserved communities, is a significant policy step in the right direction. Providing a considerable monetary incentive to primary care practitioners should favorably reduce the number of HPSAs in the nation. Thank you for your continuing efforts to promote access to health care for all Americans.

Sincerely,


Michael Fleming, MD, FAAFP
Board Chair