AAFP Backs Legislation to Increase Ranks of Rural Physicians

The AAFP is supporting a Senate bill that would give medical schools the resources to establish or expand rural physician training programs.

The Rural Physician Pipeline Act of 2009, or S. 1628, (at the THOMAS Web site, type S. 1628 in the search box after selecting "Bill Number") would award grants to medical schools for the establishment or support of existing programs that provide specialized training to students with an interest in serving rural communities. It would apply to primary care physicians as well subspecialists.

"This bill is a definite step in the right direction," said AAFP President Ted Epperly, M.D., of Boise, Idaho. "It is a good thing for rural physician development, and it is a good thing for rural communities."

Rural areas have long struggled with a lack of primary care physicians. Although a quarter of the nation's population resides in rural areas, only about 10 percent of the country's physicians practice there. However, family physicians, more than other any specialty, distribute in rural areas just like the rest of the population. Twenty percent of family physicians practice in rural areas, making them "the source of care in rural America," said Epperly.

Nevertheless, "doctors just aren't willing or able to practice in rural communities for reasons ranging from the cost of medical school to the fact that rural doctors make less money," said Sen. Mark Udall, D-Colo., who sponsored S. 1628, in an e-mail interview with AAFP News Now.

For example, according to Udall, people in rural Colorado have higher rates of diabetes, cancer and other serious diseases and conditions compared to people in urban areas. "We need to do better so people in rural Colorado aren't being left behind when it comes to health care," said Udall.

Passage of S. 1628 would help train "home-grown" physicians with a "real, personal interest in the health of their communities," according to Udall.

He is working to include his bill into the final health insurance reform bill. "My colleagues have been receptive to the idea," said Udall, adding, "I will also work to pass it as a stand-alone bill."

The bill itself is patterned after a rural physician training program at the University of Colorado School of Medicine, in Aurora, Colo., a program Udall describes as "very successful."

"My goal is to expand that program across the country," he said.

The language in the bill would require medical schools to recruit for admission students from rural areas who have a desire to practice in their hometowns or rural communities. Medical schools would develop curriculum and training focused on medical issues that are prevalent in underserved rural communities, such as trauma, obstetrics, ultrasound, oral health and behavioral health.

Medical schools also would require students to participate in rural clinical rotations while emphasizing specialties such as family and internal medicine, pediatrics, surgery, psychiatry, and emergency medicine.

The legislation also would require students to be admitted in group cohorts as a way of developing and reinforcing their commitment to practice in underserved rural communities through group social and educational activities.

"I like the recruitment of kids from hometowns to go to hometowns in cohorts," said Epperly. "If you can take in students with similar interests and keep them together, that is self sustaining to others in the group."

The legislation also seeks to promote rural community partnerships by giving priority to medical schools who demonstrate a close relationship with rural regions in terms of financing and training students during their clinical rotations. In addition, the legislation would require medical schools to help students obtain placement in residency programs that will further their rural medical education.

Epperly said, however, that the legislation is "terribly lacking" in the area of residency programs.

"It is all aimed at medical schools, and one of the most important parts of the pipeline is residency training," he said. "If you don't get students into the right residency programs with the right type of opportunities, you have just dinked the pipeline."