According to the Department of Health, “the U.S. has about 66 million people living in both rural and urban areas that the government considers underserved.” It is estimated that approximately 16,600 primary care physicians are needed to mend this deficit (CBS 2010). Dr. Howard Rabinowitz, professor of family and community medicine at the Thomas Jefferson University's Medical College, determined that only 9 percent of the physician population practices in rural and urban underserved areas. In other words, around 20 percent of the American population has inadequate or no access to a primary health care physician.
Medically Underserved Areas
Rural and urban, inner city areas have the greatest need for health care physicians. According to the Rural Health Research Center of the University of Washington, “There were 55 primary care physicians per 100,000 residents in rural areas in 2005, compared to 72 per 100,000 in urban areas. This decreases to 36 per 100,000 in isolated, small rural areas.” Residents living in medically underserved areas (MUAs) do not have ready access to medical facilities and modern technologies, or other contemporary health care services. These residents tend to be older, poorer, less educated, and uninsured. MUA residents have fewer visits to physicians and are less likely to receive preventative services due to limited access to physicians, poorer quality of care, and lack of coverage. As a result, MUA populations have higher rates of chronic illness and disabilities including obesity, diabetes, heart disease, and high blood pressure.
Need for IMGs
The shortage of physicians has been a problem for the U.S. since the 1960s. Affordable coverage is a factor in resolving the lack of quality health care in the U.S., but another major component is increasing the number of practicing physicians in MUAs. When an underserved area loses one of its physicians, it is extremely difficult to replace the individual, which has severe negative impacts on the community. One physician in a MUA may have more than 2,000 patients, and if that physician leaves or retires, the next closest physician maybe an hour away causing a major inconvenience for patients. In addition, some remote rural areas do not even contain a single primary care physician. To help alleviate the shortage issue, International Medical Graduates (IMGs) have been encouraged, through immigration laws, to partake in graduate medical education here in the U.S. According to the American Medical Association, in 1963, IMGs comprised more than 10 percent of the physician workforce in the U.S., while today that number has risen to 25 percent.
An Ongoing Issue
The shortage of physicians in the U.S. is an ongoing issue that is expected to become worse in the near future. Recruitment and retention of physicians in MUAs continue to be a challenge, especially since rural areas have a higher percent of physician generalists nearing retirement than urban areas. Another issue has been brought to attention by Dr. Stephen Foreman, the assistant vice president for research at the Pennsylvania Medical Society. He predicts that there will be a substantial shortage of physicians by 2020 affecting most specialty practices, especially those that serve the elderly. Dr. Foreman's supply and demand based analysis shows that the baby boomers are about to come into their 65-year-old age bracket starting around 2011, and it is their demand that fuels shortages. Those falling in the 65-80 year old age group require more medical care, up to three or more times the rate as younger individuals. As a result, medical care may be even less accessible in the future.
Perhaps the biggest upcoming issue is in regards to the new healthcare law here in the U.S.. The new healthcare bill will bring primary care physicians millions of newly insured patients in the next few years, which will put a heavy strain on physicians, especially those practicing in areas with shortages. According to CBS News, the bill will extend insurance to 32 million previously uninsured Americans, and the U.S. estimates a need for 13,000 more primary care physicians to satisfy demand. This amount does not include the 16,600 additional physicians needed to be filled in areas with shortages.
RATIO OF PRIMARY CARE PHYSICIANS PER 1,000 POPULATION
In the left column find the range which includes the ratio of primary care physicians per 1,000 population for the area being examined. The corresponding weighted value found opposite in the right column, should be used in the formula for determining the IMU.