Indiana tangles with shortage of rural doctors

Health care advocates in Indiana are looking at an improved training system for physicians and an expanded concept of what it means to see a doctor to help serve what's expected to be a crush of new patients seeking care starting next year.

Millions of people without health insurance nationwide are set to gain coverage in 2014 as part of the federal health care overhaul, commonly referred to as "Obamacare." As in many states, that will exacerbate problems in Indiana surrounding access to care in rural communities where is there is already a shortage of doctors and other health care providers.

"I think there's especially concern about the looming retirement of a lot of older physicians, and the expectation is because of that, and the expansion of health care, those factors will combine to make the existing shortage even more acute," said state Rep. Ed Clere, R-New Albany, the chairman of the House Public Health Committee.

The state only recently determined the depth of the shortage. The passage of the health care law in 2010 exposed the lack of information in the state about availability of health care, and it took two years to compile a comprehensive report, said David Roos, executive director of the advocacy group Covering Kids and Families of Indiana.

Indiana has 3,951 primary care "clinicians," a catch-all description that includes physicians, physician's assistants and nurse practitioners, according to an August 2012 report written by researchers with the Indiana Center for Health Workforce Studies and Bowen Research Center at the Indiana University School of Medicine.

The goal for states is to have 100 primary care physicians available for every 100,000 residents. Researchers found Indiana only had 51, and the number drops precipitously in rural communities, said Dr. Richard Kiovsky, director of the Indiana Area Health Education Centers.

Kiovsky said one possible solution is to start training doctors in the areas where there are acute shortages. Doctors are more likely to stay in a community where they grew up and went through their medical training than they are to move back home to practice after training somewhere else, he said.

As a result, groups such as the Indiana Rural Health Association are trying to get students in rural communities interested in medicine at an early age and guide them along through medical school.

"The focus is to create a training and recruitment program which literally start in grade school and ask, 'Have you ever thought about becoming a doctor when you grow up?'" Roos said.

Another answer is to adjust attitudes about who patients should see when sick. Kiovsky said if a physician's assistant can do the job as well as a fully-trained physician, that should be an option. Clere points to the industry term "extenders," or workers who literally extend the ability of doctors to take care of more patients.

"What's important is that we make sure patients are receiving high quality care from an appropriate provider," Clere said. "So there's a screening process that goes on. If the issue is beyond the scope of a physician's assistant and a nurse practitioner, then we need to make sure there is a physician available to see the patient."

In the meantime, Kiovsky said he is working with state lawmakers to further study the issue and propose changes which will make it easier to train more physician's assistants and nurse practitioners.

"The future of health care is going to be team-based," he said. "Not every person who comes in is going to need the physician's services, there are some offices that can be easily handled by a physician's assistant."