Jeffrey Alderman, M.D., is an associate professor in the Department of Internal Medicine at the University of Oklahoma School of Community Medicine in Tulsa.
With Medicaid cuts looming and the federal government entertaining efforts to shift the costs of Medicare and Medicaid on to states and individuals, the future of health care reform and reimbursement seems murkier now than ever. But gaining little attention is the issue of physician workforce. In other words – with the size and scope of our health care provider pool now shrinking, how will we meet increasing patient demand with our current available workforce?
Despite our best efforts, we simply cannot attract new physicians to the state, and a large percentage of our OU/OSU graduates leave to work outside of Oklahoma. This helps to explain why in 2009 the Commonwealth Fund ranked Oklahoma 50th in the nation for health status and health system performance. Similarly, a 2007 American Medical Association report found that Oklahoma ranks last in the US in physicians per capita, perhaps revealing why there is a 14-year difference in life expectancy between some north and south Tulsa communities.
Therefore, we depend upon a pool of providers that is ever shrinking – and an even smaller pool of doctors who are willing to practice primary care AND will accept Medicaid insurance. If deeper cuts to providers are made, the urban and rural poor, disabled, pregnant and aged patients will be forced to seek care in the only places where doctors will continue to accept SoonerCare (at higher contracted rates): the universities and the Federally Qualified Health Centers (FQHC’s.)
This is highly problematic, because many Medicaid patients have difficulty securing transportation to such far-flung facilities. Moreover, attracting physicians to work in these settings is challenging – especially when a physician can earn two to five times more income working in the private sector.
We need to graduate and retain doctors in Oklahoma who feel a sense of mission (like the innovative Dr. Jeff Brenner of Camden, NJ – who was recently featured in ‘The New Yorker.’) This line of thinking led OU-Tulsa and the George Kaiser Family Foundation to launch ‘The School of Community Medicine’ – with its emphasis on improving health status through retooling medical education.
The school’s new curriculum is designed to train medical students not just to focus on meeting the health care needs of individual patients, but on whole communities as well. Yet, when medical students are now graduating with over $200K in debt, it’s easy to see why we have a surplus of highly paid specialist physicians, such as urologists and orthopedists, opening practices in wealthy Tulsa and Oklahoma City enclaves. It is also easy to see why we have very few primary physicians throughout Oklahoma that will accept Medicaid.
Of course, the biggest losers in the new paradigm are low-income patients, who will face ever-decreasing access to medical care. In essence, we’re waiting for Superman to open a primary care practice in Oklahoma – but I worry he may have just moved to Texas to become a Neurosurgeon.
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