Specialists for Medically Underserved Regions

[Cyberdyne 101]

At least in my experience, discussions about medically underserved populations/regions usually pertain to primary care physicians. But what about specialists? Where do they fit in?
For example, can a specific region be underserved due to a lack of spine specialists? (I used spine as an example due to the prevalence of back pain). Oncology (medical, rad, surg) is another field that comes to mind. Are there certain regions that are in need of more cancer specialists?

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[RJGOP]

I would say it's not so prevalent in the United States. However, Asia, Africa and/or South America, for example, may lack an adequate amount of infectious disease doctors, or even primary care doctors. Those docs are important due to the prevalence, frequency and severity of infections in those countries.

 

[ems2doc]

There is a shortage of oncologists everywhere.
http://www.oncologypractice.com/sin...d-grows/995da42c6562b9cad9d0afa910fae7f1.html
http://www.cbsnews.com/news/us-could-face-shortage-of-cancer-doctors/
http://www.beckershospitalreview.co...-1-500-oncologists-slated-to-hit-by-2025.html
http://www.nejmcareercenter.org/article/physician-shortages-in-the-specialties-taking-a-toll/
http://www.ncbi.nlm.nih.gov/pubmed/24443733

 

[gyngyn]

At least in my experience, discussions about medically underserved populations/regions usually pertain to primary care physicians. But what about specialists? Where do they fit in?
For example, can a specific region be underserved due to a lack of spine specialists? (I used spine as an example due to the prevalence of back pain). Oncology (medical, rad, surg) is another field that comes to mind. Are there certain regions that are in need of more cancer specialists?

Specialists (especially in surgical fields) require a critical mass of referrals to maintain their skills. Low population areas will still need to send patients out for specialized care without regard to their mode of payment.

Urban areas have low income patients who may have a hard time finding someone who accepts their insurance (or lack thereof).

 

[Cyberdyne 101]

I would say it's not so prevalent in the United States. However, Asia, Africa and/or South America, for example, may lack an adequate amount of infectious disease doctors, or even primary care doctors. Those docs are important due to the prevalence, frequency and severity of infections in those countries.

I'm not very interested in primary care (at this point) so I wonder if it's practical to have ambitions to help underserved populations in the US as a specialist.

Specialists (especially in surgical fields) require a critical mass of referrals to maintain their skills. Low population areas will still need to send patients out for specialized care without regard to their mode of payment.

Urban areas have low income patients who may have a hard time finding someone who accepts their insurance (or lack thereof).

So then it's a matter of taking less if you're interested in helping these ppl.

What if you work at a county hospital as a specialist? Does that make you a salaried doctor? And does that limit the cases you take?

 

[Cyberdyne 101]

There is a shortage of oncologists everywhere.
http://www.oncologypractice.com/sin...d-grows/995da42c6562b9cad9d0afa910fae7f1.html
http://www.cbsnews.com/news/us-could-face-shortage-of-cancer-doctors/
http://www.beckershospitalreview.co...-1-500-oncologists-slated-to-hit-by-2025.html
http://www.nejmcareercenter.org/article/physician-shortages-in-the-specialties-taking-a-toll/
http://www.ncbi.nlm.nih.gov/pubmed/24443733

Thanks for the links. Although, in an older thread I was told to take such projections about shortages with a grain of salt.

 

[ems2doc]

Thanks for the links. Although, in an older thread I was told to take such projections about shortages with a grain of salt.

Yeah. It's not something that we can really say right now. There are a lot of variables. For instance, most of the studies and articles don't include anything about PAs in them. Still, the study on pubmed seems pretty good.

 

[IgEdoc]

Prevalence and severity of asthma highest in under served areas so Allergy & Immunology specialists would do well and the specialty treats all ages, irregardless whether you came from an IM or Peds background

 

[DrEnderW]

True general surgeons.

 

[Cyberdyne 101]

True general surgeons.

You mean a non-subspecialist?

 

[gyngyn]

So then it's a matter of taking less if you're interested in helping these ppl.

What if you work at a county hospital as a specialist? Does that make you a salaried doctor? And does that limit the cases you take?

It's not a matter of taking less. You have to identify your mix of payment types and decide how much you can afford to lose by seeing Medicaid patients. If you have a high enough volume of procedures that reimburse well and an efficient biller, I'm told one can do better than break even with Medicaid (I don't think I ever did!).
Working for a salary in a facility that cares for the poor is a better way (in my opinion) and you can still have multiple jobs if you need to augment income. You can do anything you have been trained to do and for which you have privileges without regard to how you are paid.

 

[Cyberdyne 101]

It's not a matter of taking less. You have to identify your mix of payment types and decide how much you can afford to lose by seeing Medicaid patients. If you have a high enough volume of procedures that reimburse well and an efficient biller, I'm told one can do better than break even with Medicaid (I don't think I ever did!).
Working for a salary in a facility that cares for the poor is a better way (in my opinion) and you can still have multiple jobs if you need to augment income. You can do anything you have been trained to do and for which you have privileges without regard to how you are paid.

Do university hospitals treat Medicaid patients?

 

[gyngyn]

Do university hospitals treat Medicaid patients?

Every one I've ever worked at did.

 

[Cyberdyne 101]

Every one I've ever worked at did.

Thanks!!

 

[RJGOP]

I'm not very interested in primary care (at this point) so I wonder if it's practical to have ambitions to help underserved populations in the US as a specialist.

Well, in that case I would recommend looking for jobs in very poor, rural areas of the United States. For example, the bayou in Louisiana. You could be any specialty you wanted, but I wouldn't recommend sub-specialization. The only problem with the bayou is almost no one speaks English, and if they do it's very slurred and basic. There are many other rural places that are under served, almost all are located in the south. Another place, if you're interested, and I'm not joking, is Alaska. Since many of the Eskimos are isolated from everyone else, it's often hard for them to receive adequate medical care. So, if you're really into helping under served regions, these are places to consider.

 

[Mad Jack]

Prevalence and severity of asthma highest in under served areas so Allergy & Immunology specialists would do well and the specialty treats all ages, irregardless whether you came from an IM or Peds background

 

[Mad Jack]

Well, in that case I would recommend looking for jobs in very poor, rural areas of the United States. For example, the bayou in Louisiana. You could be any specialty you wanted, but I wouldn't recommend sub-specialization. The only problem with the bayou is almost no one speaks English, and if they do it's very slurred and basic. There are many other rural places that are under served, almost all are located in the south. Another place, if you're interested, and I'm not joking, is Alaska. Since many of the Eskimos are isolated from everyone else, it's often hard for them to receive adequate medical care. So, if you're really into helping under served regions, these are places to consider.

There's plenty of rural underserved areas all over the country: long stretches of Northern California, the Midwest, the eastern half of the northwest, the South, Northern New England- pick a rural area, and chances are it'll be underserved.

Pulm is a pretty solid specialty for rural practice, since you can do a good mix of small hospital inpatient and outpatient to fill your schedule.

 

[RJGOP]

There's plenty of rural underserved areas all over the country: long stretches of Northern California, the Midwest, the eastern half of the northwest, the South, Northern New England- pick a rural area, and chances are it'll be underserved.

Pulm is a pretty solid specialty for rural practice, since you can do a good mix of small hospital inpatient and outpatient to fill your schedule.

Those areas may be rural, but they in higher populated areas, which allow for better access to care. Yes, there are some areas that are under served in the places that you mentioned, for example Maine. Especially if you live in very northern Maine. However, those people tend to be much wealthier than the people in the places I mentioned, and are better educated, thus knowing better when to contact a doctor if they have a concern.

 

[Mad Jack]

Those areas may be rural, but they in higher populated areas, which allow for better access to care. Yes, there are some areas that are under served in the places that you mentioned, for example Maine. Especially if you live in very northern Maine. However, those people tend to be much wealthier than the people in the places I mentioned, and are better educated, thus knowing better when to contact a doctor if they have a concern.

Lol, that's not true at all. I live in Maine, and the average income of people in rural Maine is quite low, as is their proximity to care. Only the southeastern coast of the state has a decent economy, but that's largely a seasonal thing as it is mostly tourism-based. It certainly isn't the grimmest of the grim (that nod goes out to Appalachia and the various Indian reservations) but it's poor, rural, and under educated compared to the national average and the people certainly need help.

http://bangordailynews.com/2014/03/...e-would-benefit-most-from-medicaid-expansion/

http://www.collegeforme.com/case_for_college.html

http://bangordailynews.com/2011/10/...hest-but-it’s-no-2-on-public-assistance-list/

 

[RJGOP]

Lol, that's not true at all. I live in Maine, and the average income of people in rural Maine is quite low, as is their proximity to care. Only the southeastern coast of the state has a decent economy, but that's largely a seasonal thing as it is mostly tourism-based. It certainly isn't the grimmest of the grim (that nod goes out to Appalachia and the various Indian reservations) but it's poor, rural, and under educated compared to the national average and the people certainly need help.

http://bangordailynews.com/2014/03/...e-would-benefit-most-from-medicaid-expansion/

http://www.collegeforme.com/case_for_college.html

http://bangordailynews.com/2011/10/20/news/state/maine’s-poverty-rate-isn’t-the-highest-but-it’s-no-2-on-public-assistance-list/

I didn't say they were wealthy, I said they were WEALTHIER than the people who I mentioned, most of whom are dirt poor. They, naturally, are also very uneducated, they likely have the equivalent education of a second grader. Also, I was just pointing out places which need care the most, and quickly, but yes, there are more places in the U.S. that could use more and proximal medical care.

 

[Cyberdyne 101]

Thanks for the links and responses!
Maybe in the future I'll be the local specialist in Charming, California

 

[Danbo1957]

There are many academic programs (U. Wash, New Mexico, Colorado, etc.) that specialize in rural medicine. They are very interested in getting general surgeons and orthopedic surgeons into underserved areas, doing so is of great concern here in Texas as well. Specialist are a "luxury" in many cases, and by definition need to be in more populated areas in order to maintain a practice-- but many travel. Specialists from Texas Tech programs have an "area" that they cover throughout West Texas; an oncologist may visit five rural towns in a given month and see a hundred patients.

 

[VanEman]

At least in my experience, discussions about medically underserved populations/regions usually pertain to primary care physicians. But what about specialists? Where do they fit in?
For example, can a specific region be underserved due to a lack of spine specialists? (I used spine as an example due to the prevalence of back pain). Oncology (medical, rad, surg) is another field that comes to mind. Are there certain regions that are in need of more cancer specialists?

Rural underserved areas often have a shortage of psychiatrists. UC Riverside just created a few residencies in psychiatry to hep fill the need.

 

[Cyberdyne 101]

Rural underserved areas often have a shortage of psychiatrists. UC Riverside just created a few residencies in psychiatry to hep fill the need.

It's refreshing to hear that residency spots are being created in needed areas.