Many of us are familiar with discussions surrounding health care. Whether is pertains to insurance coverage, the cost of health care, the need for physicians or someone’s ability to access to health care, these discussions have been central to our political, social, and economic climate since the before the turn of the century. Why are these discussions so important? What is the basis of these conversations? Well, the most basic element in these discussion is about access to medical service. Meeting with a doctor that understands your culture, uses your insurance plan, or can provide care at a cost effective price is an irrelevant discussion is there simply is no doctor available for you to see. Areas of the country that have a shortage of physicians are considered medically underserved areas.
The Health Resources and Services Administration website states, “a Health Professional Shortage Area (HPSA) or a Medically Underserved Area/Population (MUA/P). HPSAs may be designated as having a shortage of primary medical care, dental or mental health providers. They may be urban or rural areas, population groups, or medical or other public facilities. MUAs may be a whole county or a group of contiguous counties, a group of counties or civil divisions, or a group of urban census tracts in which residents have a shortage of health services. MUPs may include groups of persons who face economic, cultural or linguistic barriers to health care.” Although health professional shortage areas and medically underserved areas are similar, there is a fine distinction in how they are defined.
A health professional shortage area includes shortages in primary care, mental health, or dental care. It includes functioning facilities such as hospitals, clinics, correctional facilities, and community health centers that have a shortage of providers. Nationally there is an approximate shortage of 7,167 doctors. However, this estimate may be vastly underestimated, as programs such as the American Medical Association previously estimated a shortage of 62,900 physicians by 2015. These shortages are located all over the country. In face, a map of Health Professional Shortage Areas shows that almost every state is affected by a physician shortage and well-served and underserved areas can be right next to each other. The Federal Register website even recognizes entire states as medically underserved in the Federal Employees Health Benefits. These states are Alabama, Arizona, Idaho, Illinois, Louisiana, Mississippi, Missouri, New Mexico, North Dakota, Oklahoma, South Carolina and Wyoming. There are equivalent maps of dental care and mental health care shortage areas also on the HRSA website.
Medically underserved areas are designations for areas of the population that do not have adequate access to primary care medical services. It is important to note that these medically underserved areas are not evenly distributed throughout the population. Some subsets of the population are more negatively affected than others. Populations that have increased barriers to healthcare such as economic, cultural, or linguistic barriers are groups such as the homeless, members of low socioeconomic status (low-income, Medicaid users), Native Americans, and migrant farmworkers. While these populations are not the only groups affected, their difficulties in accessing medical care are disproportionately larger than other groups. If you are interested to see if you live in a MUA, you can search your for your county’s information here.
Who is most likely to want to work in these areas? However, it is important to note that there are a few predictors of the types of physicians willing to work with underserved populations. A study titled Working with the Medically Underserved states that these factors are, “being a member of an underserved ethnic or minority group, having participated in the National Health Service Corps, having a strong interest in practicing in an underserved area before attending medical school, and growing up in an underserved area.” It is important to note that this is a subset of the medical professional population. Physicians are not the only providers working to increase access to care. As of 2016, 63.4% of the 153 of the nurse led health clinics associated with the National Nursing Centers Consortium are located in underserved areas. However, not every provider (nurse, physician, nurse practitioner, physician assistant, or otherwise) wants to work in these areas. Thus, there needs to be a draw or incentive to attract them.
So what is being done to address the need? There are a number of incentive programs that are designed to attract physicians to need areas. For example, there are scholarship and loan repayment programs, bonus payments from the Center for Medicare and Medicaid Services and better reimbursement rates for physicians practicing in rural health clinics. Additionally, studies have shown that when medical schools partner with free clinics, there are benefits for both parties. This is a potential solution for closing the gap in these medically undererved areas, because “students exposed to underserved populations may be more likely to pursue primary care fields and practice in underserved communities, improving health-care infrastructure.” Even now, medical schools offer information for students interested in these areas. Case in point, University of South Florida has a handout available to students. However, they have to seek the opportunity themselves. Although this type of solution does not offer instantaneous results, it may produce longevity. Physicians my develop an interest in working with underserved populations while in school, producing a change in career goals and interests, rather than working in underserved areas as a temporary solution for loan repayment.