Other Voices

Unless we act now, Texas doctors could become an endangered species

Dr. Robert DeLuca sees rural health care’s challenges and benefits at his private practice office in Eastland, Texas.
Dr. Robert DeLuca sees rural health care’s challenges and benefits at his private practice office in Eastland, Texas. pmoseley@star-telegram.com

Doctors are fast becoming an endangered species in the Lone Star State.

According to one recent report, Texas ranks 41st in the nation for the number of physicians per 100,000 people.

Fourteen percent of counties have no physicians at all. Rural communities have it especially bad.

In the last three years, 15 of Texas’ rural hospitals have closed.

Texas isn’t the only place where doctors are in short supply. By 2025, the national doctor shortage is expected to reach 90,000.

Who better to address this gap than the institutions responsible for training the next generation of physicians?

To do so, medical schools must find ways to encourage today’s doctors-in-training to set up shop in the nation’s most under-served areas.

Roughly 20 percent of Americans live outside of cities. But only about 10 percent of physicians practice in these areas.

In Texas, a mere 2.5 percent of state physicians reside in a rural county.

The lack of primary care physicians is particularly troubling. Roughly half of Texas’s counties lack sufficient access to primary care.

The story is the same elsewhere.

Only 37 percent of North Dakota’s primary-care needs are currently being met, while Missouri has only enough physicians to meet 30 percent of its primary-care demand.

California’s mostly urban San Francisco Bay Area has 86 primary care doctors for every 100,000 residents; the mainly rural San Joaquin Valley has only 48.

Fortunately, a few efforts to encourage physicians to practice in rural communities have shown promise.

For example, Texas’ Physician Education Loan Repayment Program offers doctors up to $160,000 in return for practicing for at least four years in an area suffering a physician shortage.

The program puts particular emphasis on recruiting primary-care doctors.

The National Health Service Corps is a federal initiative that awards scholarships and loan repayments to doctors willing to practice for two years or more in an under-served area.

Physicians who participate in this loan-repayment program are over twice as likely to practice in a rural community as doctors who don’t, according to a recent study.

As encouraging as such initiatives may be, the rural physician shortage requires a more comprehensive approach — one that starts with medical schools.

Schools should give priority to applicants who intend to practice in disadvantaged and rural communities once they graduate.

Some institutions are already leading the way.

For example, the “Scholars in Rural Health” program at the University of Kansas Medical School recruits undergraduates from rural areas early in their college careers.

Students who are willing to complete an MD and practice in rural Kansas are eligible for admission as early as their sophomore year of college.

Some are able to earn full scholarships that cover tuition, room and board.

Medical schools can also encourage students to seek residencies in rural areas.

Indeed, in more than 80 percent of cases, doctors go on to practice within 50 miles of where they complete their residency.

By partnering with rural and inner-city hospitals on residencies and other training programs, medical schools can help ensure that more of their students choose to practice in disadvantaged areas.

The school I lead, St. George’s University, is putting this theory into practice.

Our CityDoctors program, for example, offers full and partial-tuition scholarships to students who go on to practice primary care at public hospitals in some of New York City’s most disadvantaged communities.

Texas’ doctor shortage is representative of a nationwide crisis.

As the training grounds for the tomorrow’s physicians, med schools are best-equipped to alleviate this crisis.

They must make doing so a priority.

G. Richard Olds MD is president of St. George’s University in Grenada.