Champion Rural Health, Speakers Urge Congressional Aides

You can rescue rural America from its shortage of health care professionals, two speakers -- one a family physician -- told congressional aides and others at a Capitol Hill forum recently. The message is one the Academy hopes many FPs will take to their lawmakers, targeting Title VII, Section 747, of the Public Health Service Act.

Research indicates rural populations are sicker, older, poorer and more likely to be uninsured than urban and suburban residents. Twenty percent of Americans live in rural communities, but only 9 percent of the nation's physicians work there. To make matters worse, the average stay of a rural primary care physician is only seven years.

"There are two major challenges," FP Howard Rabinowitz, M.D., said at the forum. "First, train people and get them to go to rural areas. Second, keep them there. It's pretty simple."

He heads the Physician Shortage Area Program at Thomas Jefferson University, Philadelphia. The PSAP graduates about 14 medical students a year who enter rural family medicine, 6 percent of a class of 223. And those 14 have staying power. For PSAP alumni 11 to 16 years after beginning rural practice, 68 percent are in the same area, and another 11 percent have moved to a different rural area.

PSAP's recipe for success: Select rural applicants committed to practicing family medicine and returning to a rural area; give them rural mentors throughout medical school; and place them in rural clerkships.

The other forum speaker, Janet Corrigan, Ph.D., study director for the Institute of Medicine report Quality Through Collaboration: The Future of Rural Health, issued last fall, shared IOM's perspective on rural FPs.

Our (IOM) committee felt there was a strong sense that family practice prepares physicians better for the rural practice setting and therefore they're more likely to practice in rural areas -- they have a broader scope of practice," she said. "We'd also like to increase the supply of pediatricians and internists. And physician assistants are really critical; nurses, emergency care providers -- all those other members of the health care team."

So what should Congress do?

"Increase the funding streams that already exist," Rabinowitz told the forum's 80 participants, including 30 legislative aides. He and others at the forum specified Titles VII and VIII of the Public Health Service Act, as well as funding for area health education centers and graduate medical education.

The Jan. 25 forum was sponsored by AAFP's Robert Graham Center in partnership with the IOM, Society of Primary Care Policy Fellows and Academic Family Medicine Advocacy Alliance.