Almost 800,000 uninsured Missourians became eligible for coverage through the federal health insurance marketplace earlier this year. As the state continues to consider extending coverage to even more individuals through Medicaid expansion, the need for primary care doctors will increase as well.
I spoke with Mary Becker, an MHA Senior Vice President, about why these areas are losing primary care doctors and what it means for an aging rural population.
This interview has been condensed and edited for content and clarity.
Why is the availability of primary care doctors an important issue for rural Missourians?
We have an older population. In addition, their health status is much poorer in the rural Missouri. So there are increased rates of obesity, high diagnosed rates of high blood pressure and high cholesterol. So again, the ability for those individuals to access health care services to prevent greater disease is really critical.
The number of physicians in Missouri has increased over the past three years according to your report, but rural parts of the state have lost more doctors. Why are these rural places losing physicians?
Quite frankly in Missouri we've had some changes that make it a less attractive place for physicians to practice overall. Missouri's Medicaid program has not been expanded. There are not hospitals in all parts of rural Missouri and salary that a primary care physician makes is much less than that of a specialist physician. So when individuals are going into medical school, often they will choose a specialty that will pay more once they are through school because the debt that students incur going to medical school is quite high.
Your report briefly discusses the Affordable Care Act, saying that although the ACA didn't create this shortage of primary care doctors, it will intensify the shortage. And the report goes on to say that the ACA does not adequately offer policy options to address this problem. From those statements, it almost seems like something meant to help the healthcare situation in Missouri is just aggravating current problems.
We are seeing increased numbers of insured individuals through the healthcare marketplace. There are 150,000 people who now have coverage through the healthcare marketplace, at least a percentage of which were likely not insured before, so that does increase the demand on the primary care system.
What policy options do you think could improve the disparity of rural primary care doctors?
Well I think there are a variety of things that could be looked at. Incentive programs to help repay medical school debt, looking at how to increase the use of advanced practice nurses in the state of Missouri. But it will require working in partnership with not only state government but with medical schools, with hospitals, with clinics to provide a really broad look at the options that are available to make it a more attractive environment for primary care physicians.