Health Status of the Uninsured in Geographical Health Professional Shortage Areas
Distribution of Primary Care Physicians
In the United States, nearly 67 million people live in Primary Care Health Professional Shortage Areas (HPSAs), where there are too few primary care providers to meet the demand. This shortage of primary care health professionals is exacerbated by their unequal distribution across the United States. For example, 21 percent of Americans live in rural areas, yet only 10 percent of physicians practice there. Due in part to this distribution, people living in designated HPSAs are more likely to suffer from poor health and higher rates of diabetes, obesity, chronic conditions and psychological distress than residents of other areas.
Studies have found that the location, mission and curricula of medical schools are strongly related to the likelihood that graduates will chose to practice in underserved areas. For example, a rural clinical rotation during medical school is a strong predictor of a medical student’s decision to practice in a rural area. However, most medical schools are located in urban areas, and most students are not exposed to rural regions.
States have pioneered a variety of programs to encourage a more even distribution of primary care providers and to add incentives to practice in underserved areas.
Since 2010, the Colorado Health Foundation has funded the Physician Loan Repayment Program, which has awarded $5.4 million through 47 grants to clinics and physicians who practice in Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs) or other community funded safety-net facilities in rural or underserved urban communities in the state.
The West Virginia Rural Health Education Partnership and Area Health Education Centers offer numerous educational opportunities for medical and health professionals in rural settings. Programs are designed to increase recruitment and retention of health care providers in rural areas by requiring that students complete rural rotations and become qualified rural health professionals.
Alaska Natives are being trained to provide mid-level dental care and community-based oral health prevention programs in their remote villages. DENTEX, a program created through a partnership between the University of Washington’s MEDEX Northwest Physician Assistant Training Program and the Alaska Native Tribal Health Consortium, trains Alaska Natives as dental health aide therapists to address community-level dental disease prevention. Upon graduating from the two-year program, the aides serve as mid-level providers in remote communities, communicating with their supervising dentist via the Internet or working directly with a supervising dentist to expand access and availability of care.
Sources: U.S. Department of Health and Human Services, Designated Health Professional Shortage Areas (HPSA) Statistics (Washington, D.C.-or wherever they are: DHHS, Bureau of Health Professionals, Health Resources and Services Administration, April 12, 2011). Howard K. Rabinowitz and Nina P. Paynter, “The Rural vs Urban Practice Decision,” Journal of the American Medical Association 287, no. 1 (Jan. 2, 2002): 113. R.A. Rosenblatt et al., “Which medical schools produce rural physicians?” Journal of the American Medical Association 268, no.12 (September 1992): 1559-65.
Published: May 2011