Washington, Greene counties medically ‘underserved’
Dr. Mark Harris poses in one of his chemistry labs in the Swanson Science Center on the campus of Washington & Jefferson College.
Sarah Stovar is a pre-medicine student at Washington & Jefferson College who hopes to be a primary care physician. The summer after his freshman year, W&J pre-medicine student Joseph Williams traveled to Merida, Mexico, with Presidents Without Borders, a W&J service organization that introduces students to underserved areas in the field of medicine, where he helped numerous residents, including this young girl.
Sarah Stovar is a pre-medicine student at Washington & Jefferson College who hopes to be a primary care physician.
The causes of the nationwide primary care doctor shortage are abundant and complex.
It is estimated that 16,000 new primary care physicians are needed to meet the current demand; 52,000 will be needed by 2025.
Dr. Mark F. Harris, professor of chemistry at Washington & Jefferson College, chairs the college’s Committee on Health Professions, an advisory panel that works with students planning to go into the medical field. Since starting at the college 17 years ago, he hasn’t seen a decline in pre-med students wanting to go into primary medicine, but students in this stage of their education tend to believe they will specialize.
“There is a prestige difference,” Harris said. “Part of it is the person’s drive, striving for what they perceive as a higher level.”
In addition to prestige, Harris believes medical students think they will be boxed in by becoming primary care doctors; they think they will only treat patients with “run-of-the-mill” conditions, like colds and coughs.
“They don’t know the breadth of interactions a primary care doctor will have,” said Harris. “They think they won’t get to flex their medical muscles.”
Two pre-med students from W&J, Sarah Stovar and Joseph Williams, illustrate the different paths medical professionals take.
Stovar, a junior from Butler, plans to become a primary care physician, a desire she had as a child. She admired her own family physician, Dr. Joseph J. Gribik, so much, she “wanted to be him.”
After being selected to attend a five-day primary care intensive for premed students at Penn State Hershey College of Medicine, Stovar’s decision was reinforced.
“You see everyone from babies to adults, and different illnesses,” Stovar said. “I feel I’ll really be putting my skills to use and will be able to establish a bond with my patients.”
Williams, on the other hand, said he always knew “primary medicine is not for me.”
The summer after his freshman year of college, Williams traveled to Merida, Mexico, with Presidents Without Borders, a W&J service organization that introduces students to underserved areas in the field of medicine. During the two- week trip, he assisted volunteer physicians in everything from vision checks to cleaning teeth and dispensing vitamins.
He plans to become either a pain specialist or go into a pediatric specialty.
“I feel like it’s one of the most rewarding fields,” Williams said.
W&J provides their premed students a chance to experience different specialties through shadowing and internships.
Harris said that a recently developed shadowing opportunity with primary care physicians at Washington Family Practice was “eye-opening” for many students.
While colleges like W&J are implementing programs to introduce primary medicine to students, the nationwide doctor shortage is inevitable.
Robert Richardson, state Department of Health director of the Bureau of Health Planning, said that Pennsylvania is unique, in that there are areas with an overabundance of doctors, such as in the Pittsburgh area, and rural areas that are underserved.
To get to the root of the matter, he explained a few causes of the deficit.
First, on March 23, 2010, President Obama signed the Affordable Care Act into law, giving millions of Americans access to health insurance, thus increasing the number of people being seen by doctors.
Second, the number of physicians choosing to go into general practice has decreased.
“They are the least well-paid,” Richardson said. “They have to know a lot of different areas and they work longer hours.”
When medical students graduate from medical school, “their debt load is so high. A high income to help pay that off is attractive,” said Harris of specializing.
According to a 2013 U.S. Senate report, while half of patient visits are for primary care, just seven percent of medical school graduates choose a career in primary medicine.
Finally, said Richardson, “It’s a distribution issue.”
It can be difficult to recruit primary care doctors to very rural areas, or areas that have a low socioeconomic status.
According to a December 2013 study completed by the state health department, there are 155 “critical areas” in Pennsylvania that have 1 physician for every 3,500 or more people. While Washington and Greene counties are well above the critical level, with one doctor for every 671 to 1,351 people, most of Greene and the northern section of Washington are considered medically underserved populations.
Even within areas that have an abundance of physicians, “there are areas within that have a shortage,” said Richardson. “Physicians are not providing services to the uninsured or those who are not on Medicaid. Those people have physicians but they are not accessible to them.”
The state health department now has many initiatives in place to alleviate the shortfall.
Privately owned community health centers that treat underserved patients receive funding from the Health Resources and Services Administration. According to Richardson, there are 260 federally funded health care centers in Pennsylvania employing many primary care physicians.
The Department of Health also offers a loan-forgiveness program to new physicians, physician assistants and nurse practitioners who sign a contract to work in an underserved area for two years.
In addition, the department participates in the J-1 and National Interest Waiver program, in which international doctors in the United States on educational visas can stay in the country for three years if they practice medicine in underserved areas. Currently, there are approximately 100 doctors in Pennsylvania taking advantage of the program.
A new program opens up spots for medical school graduates in residency programs. The department provides funding for up to nine new slots in residency programs that train primary care doctors for rural and underserved areas.
“While that may not seem like a lot, 70 to 80 percent of all physicians will enter practice in the general vicinity where they do their training,” Richardson said. “We’re increasing the possibility that we’ll have more doctors stay in the state.”
While Williams and Stovar differ in which paths they wish to take, they both would eventually like to practice in more urban areas.
“I’d like to work in underserved areas,” Stovar said. “But eventually I definitely want to live and practice in a large city.”