"We're the middle of everywhere," she said, noting the
Former residents of Sheraden,
"I think our health care is good," she said. "We just don't require a lot of health care but those that do seem to get by. I think it is available but everyone shops out of town, so they plan their doctors' appointments along with their shopping trips."
Trees vs. treatments
In truth, physicians in
"I know them, and they know me," he said of his patients, with the usual problems of hypertension, diabetes and high cholesterol. "We get patients from as far south as
What the area lacks, he said, is a psychiatrist or psychologist. He does concede that doctors aren't eager to move to
That's why he was coaxed out of retirement.
Despite those opinions, rural America and low-economic areas of the country have too few primary care physicians and certain medical specialists, including most rural counties in southwestern
The wife of a rural doctor in that area said her husband in his 60s works 12 to 14 hours each weekday at two health centers and makes rounds at a local hospital, with all the paperwork being done each evening. On weekends, he does rounds at two nursing homes.
She said he'd likely be too busy to call back but she'd give him the message. He never called.
In its most recent report, the
That's a shortage of 35,600 primary care physicians,10,200 medical specialists, 33,200 surgical specialists and 32,600 other positions, all while aging baby boomers, 65 and older and needing the most health care, soon will top 40 percent of the nation's population.
"The total projected physician shortage persists under every likely scenario, including increased use of nurse practitioners and physician assistants, greater use of alternative settings such as retail clinics, delayed physician retirement and rapid changes in payment and delivery," the
Other analysts said the actual problem is doctor distribution, with fewer than 25 percent of doctors in family medicine and more than 75 percent involved with medical specialties.
Medical schools tend to admit students from upper-crust society who become doctors and return to upper-crust communities or university health centers to complete their medical residencies and launch careers.
Too few students from rural, low-income areas lead to too few physicians returning home to practice medicine. The family doctor shortage especially affecting rural and low-income communities nationwide could be corrected simply by improving reimbursements for primary care and recruiting and encouraging more students from deficit areas to become doctors.
"About 80 percent of all medical school students come from the top 40 percent of income and only about 5 percent of all med students come from the lower 20 percent of income," said
Normal, day-to-day human behavior, he said, has people gravitating home or to communities similar to those where they grew up. "When you compose a medical school and when your students are not from medically under-served areas, what do you expect?"
The ideal family physicians-to-specialists ratio of 40-60 or 50-50 would lower health costs and lead to better, more continuous care, said
"From our organization's point of view, more primary care is better. We just created a system that's out of balance and continues to be out of balance,"
"If you have a primary care physician serving as quarterback and allow him or her to make referrals, fewer people will be referred. But when they are, they don't get lost in the system," he said.
Only 75 percent of Americans currently have a primary care physician, with the remaining 25 percent using specialists or emergency rooms for basic treatment at high cost. A 50-50 split of family doctors and specialists would resolve that problem.
"Whether it's a general internist or family physician, they understand the complexities of the health care system and that's extremely valuable to patients,"
Even more shortages
The national physician shortage is compounded by 20 million more people with health insurance under the Affordable Care Act and a scarcity of medical residency programs for new doctors to complete their training. Each year about 500 new doctors fail to get into residency programs, the
The association and the
Meanwhile, there are only 28,250 psychiatrists in
"What we are seeing is that
In a survey last summer, area medical schools said they were training more rural physicians.
It also has a
"The national physician shortage is something we've been aware of for quite some time and have, in part, driven us as well, and many other medical schools, to increase enrollment. We currently are up to 110, which is an increase from 87 back in the 1980s," said
"So much of this is about moving education into the community practice and get our learners to see how they practice medicine in that setting and perform as a community-based caregiver,"
Pitt isn't rural
Based on that philosophy, he said, Pitt has maintained an average class size of 148 students.
"One of our emphases is generating the next generation of leaders in primary care fields -- those with big ideas to solve problem A or B," he said. "Pitt graduates are going to some of the top programs and residencies, leading to careers where they are leaders in the field."
That's to say, the average Pitt grad, like many new physicians, has different ideas about the center of everywhere.
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