Lack of primary care or lack of doctors in underserved areas?

[88559]

Hello, I was hoping to get some discussion going and some different opinions on this. At different schools as well as just from other students I keep hearing the need for primary care doctors especially in underserved areas. I plan on working in the underserved communities but I was wondering, is it just primary care doctors that these areas need? Why not other doctors? I am assuming the idea is that if we have good primary care, there will be less need for more expensive treatments/specialists. Let me know what you guys think!

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[Goro]

This is a job for @cabinbuilder!

But yes, rural/underserved areas need specialists as well as Primary Care docs.

 

[cabinbuilder]

Hello, I was hoping to get some discussion going and some different opinions on this. At different schools as well as just from other students I keep hearing the need for primary care doctors especially in underserved areas. I plan on working in the underserved communities but I was wondering, is it just primary care doctors that these areas need? Why not other doctors? I am assuming the idea is that if we have good primary care, there will be less need for more expensive treatments/specialists. Let me know what you guys think!

Thanks @Goro . So I have spent the last 5 years doing locums and going to very rural/frontier to mildly rural communities because there is a huge primary care shortage. Because of the primary care shortage there is also an urgent care doctor shortage since no one can get into their primary doctor anymore. I just finished an 8 month stint in Southern Oregon where the wait to get established with primary care is 6-8 months and 4-6 weeks for established patients (on a good day). There are no slots either for same day sick appointment so everyone shuttles to urgent care because they don't trust their local ER either (half the time I didn't trust the ER). Rheumatology stopped taking new patients. Neurosurgery was a 3 month wait.

Yes, there are some specialists in rural areas: general surgery, ortho, podiatry, cardiology(sometimes), derm(sometimes), rheumatology(you hope), OB, Peds, oncology. Remember that all the specialists generally get their patients as referrals from primary care and urgent care for follow-up.

If you want to work in a rural/underserved area, every hospital is actively recruiting for primary care doctors. Remember that ALL NUMBERS ARE NEGOTIABLE in a contract. They just put down what they hope you will take and they expect a counter offer from you (they will take it if reasonable).

 

[Cardboard101]

Wow. I didn't know it was so bad. I lived in San Diego/San Francisco and if I want to see a doctor, I call my insurance tell them when I'm free and they have an appointment for me same week often same day. When you say the patients don't trust their local ER, what do you mean?

 

[Rekt]

The shortage is largely overestimated, it's really just a misallocation of physicians.

 

[DrMikeP]

Hello, I was hoping to get some discussion going and some different opinions on this. At different schools as well as just from other students I keep hearing the need for primary care doctors especially in underserved areas. I plan on working in the underserved communities but I was wondering, is it just primary care doctors that these areas need? Why not other doctors? I am assuming the idea is that if we have good primary care, there will be less need for more expensive treatments/specialists. Let me know what you guys think!

Yes, there is a shortage of quality specialists. My elderly father (who lives in a rural area) went in for urinary issues on Friday. The 80+ yr old general surgeon decided over the weekend (without me being told) to do surgery and remove a cancerous bladder tumor and wanted to do a round of "general chemo," w/o even consulting an oncologist, which is the standard there. They just don't have the specialists so family docs and general surgeons do everything and often based on outdated tx standards.

 

[88559]

Thanks @Goro . So I have spent the last 5 years doing locums and going to very rural/frontier to mildly rural communities because there is a huge primary care shortage. Because of the primary care shortage there is also an urgent care doctor shortage since no one can get into their primary doctor anymore. I just finished an 8 month stint in Southern Oregon where the wait to get established with primary care is 6-8 months and 4-6 weeks for established patients (on a good day). There are no slots either for same day sick appointment so everyone shuttles to urgent care because they don't trust their local ER either (half the time I didn't trust the ER). Rheumatology stopped taking new patients. Neurosurgery was a 3 month wait.

Yes, there are some specialists in rural areas: general surgery, ortho, podiatry, cardiology(sometimes), derm(sometimes), rheumatology(you hope), OB, Peds, oncology. Remember that all the specialists generally get their patients as referrals from primary care and urgent care for follow-up.

If you want to work in a rural/underserved area, every hospital is actively recruiting for primary care doctors. Remember that ALL NUMBERS ARE NEGOTIABLE in a contract. They just put down what they hope you will take and they expect a counter offer from you (they will take it if reasonable).

Thank you for your answer! This clarifies it up a lot. Can you explain what you mean by locals not trusting their ER? Also, for these areas, when people get referred to a specialist, where would they go to see one if there's none in the area?

It's terrible that people have to wait so long to see a physician. From you experience, have you seen any improvement in these areas overtime? If so, what seems to be most helpful in combating the health problems in these areas?

 

[deleted446889]

Sorry, I don't really know much about all this but I'm just wondering, exactly how far are these rural, underserved areas from the usual healthy cities? If these areas are not tooo far away (say an hour or two), is it possible for physicians to live in the nice places and commute to work in these areas of high demand? Surely the opportunities and compensation would be better than the scraps left in big cities?

Are there other negative aspects to working in such areas?

 

[DrMikeP]

Sorry, I don't really know much about all this but I'm just wondering, exactly how far are these rural, underserved areas from the usual healthy cities? If these areas are not tooo far away (say an hour or two), is it possible for physicians to live in the nice places and commute to work in these areas of high demand? Surely the opportunities and compensation would be better than the scraps left in big cities?

Are there other negative aspects to working in such areas?

Pay at underserved hospitals is often notoriously low in comparison. The patients often are in poorer condition. The technology is lacking. Mental health services often don't exist, so it falls to the pcp who isn't equipped to provide a full range of needed services. Many patients can't pay and fall into the working poor range. They might have Obamacare but a $4000 deductible means you often don't get paid for follow up visits unless they go into the hospital. Some are several hours from a major city. etc etc. There are several good AMA reports on underserved rural areas and healthcare challenges. All of that said, if you want to do something to help others it's awesome. The public service loan forgiveness program was helping attract drs to such areas for 10yrs, but the administration is pushing hard to limit reimbursement to $70-80K max so not sure how long before that program disappears.

I often thought about doing something like Doctors w/o Borders but with a focus on rural health in the US.

 

[TheOther]

Sorry, I don't really know much about all this but I'm just wondering, exactly how far are these rural, underserved areas from the usual healthy cities? If these areas are not tooo far away (say an hour or two), is it possible for physicians to live in the nice places and commute to work in these areas of high demand? Surely the opportunities and compensation would be better than the scraps left in big cities?

Are there other negative aspects to working in such areas?

From my understanding, because of the shortage, a rural primary care physician is likely be on call a lot. A LOT. There's just no one else, especially in emergent cases. I suppose it depends on the healthcare system, but generally, I believe it's harder to live 1-2 hours away as a rural doc.

 

[AvrgPreMedKid]

Thank you for your answer! This clarifies it up a lot. Can you explain what you mean by locals not trusting their ER? Also, for these areas, when people get referred to a specialist, where would they go to see one if there's none in the area?

It's terrible that people have to wait so long to see a physician. From you experience, have you seen any improvement in these areas overtime? If so, what seems to be most helpful in combating the health problems in these areas?

Wow. I didn't know it was so bad. I lived in San Diego/San Francisco and if I want to see a doctor, I call my insurance tell them when I'm free and they have an appointment for me same week often same day. When you say the patients don't trust their local ER, what do you mean?

Simple definition of "trust": belief that someone or something is reliable, good, honest, effective, etc.
ER = Emergency Room

The locals do not believe their emergency room is reliable, good, honest, effective, etc.

 

[88559]

Pay at underserved hospitals is often notoriously low in comparison. The patients often are in poorer condition. The technology is lacking. Mental health services often don't exist, so it falls to the pcp who isn't equipped to provide a full range of needed services. Many patients can't pay and fall into the working poor range. They might have Obamacare but a $4000 deductible means you often don't get paid for follow up visits unless they go into the hospital. Some are several hours from a major city. etc etc. There are several good AMA reports on underserved rural areas and healthcare challenges. All of that said, if you want to do something to help others it's awesome. The public service loan forgiveness program was helping attract drs to such areas for 10yrs, but the administration is pushing hard to limit reimbursement to $70-80K max so not sure how long before that program disappears.

I often thought about doing something like Doctors w/o Borders but with a focus on rural health in the US.

I am very uncertain about these loan forgiveness programs because part of me feels like the source of the issue is deeper than just getting physicians into the area and the loan forgiveness program is just a band aid to the actual issues that no one wants to address because it is so complicated. :S

 

[DrMikeP]

I am very uncertain about these loan forgiveness programs because part of me feels like the source of the issue is deeper than just getting physicians into the area and the loan forgiveness program is just a band aid to the actual issues that no one wants to address because it is so complicated. :S

Agree, it isn't a fix but it did make doing 10yrs with payments capped at 10-15% of income and loans paid off worth while to keep someone from going broke when trying to help others.

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[cabinbuilder]

The shortage is largely overestimated, it's really just a misallocation of physicians.

I do not agree with this. You can't force anyone to move to a rural place if that is not what they want.

 

[cabinbuilder]

Thank you for your answer! This clarifies it up a lot. Can you explain what you mean by locals not trusting their ER? Also, for these areas, when people get referred to a specialist, where would they go to see one if there's none in the area?

It's terrible that people have to wait so long to see a physician. From you experience, have you seen any improvement in these areas overtime? If so, what seems to be most helpful in combating the health problems in these areas?

The quality of the ER comes down to the doctor who treats you there. I can't tell you how many times I have sent patient's to the ER only to have them come back to me in urgent care later telling me, "they didn't do anything". No labs, no scan, etc. I can tell you I look at the ER schedule and send patients according to who I know is on.

When I worked in North Wyoming, patient would travel to Billings, MT for care. In Southeast Alaska, patients travel to Juneau or Anchorage for care (or Seattle). In Central Nevada, patients travel to Reno or Vegas. In Southern Oregon, patients go to OHSU in Portland. Most of these areas patients travel up to 4 hours away to see a specialist.