Three Perspectives on the Physician Shortage Crisis: An HCE Original Report (Part 3 of 3)

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healthcareix-itunes-artworkAs we wrap up our look at the different perspectives on the physician-shortage crisis, we turn to rural healthcare. In Part 1, we learned that academic medical centers like the Cleveland Clinic are concerned with how the shortage will affect them in the long-term and are planning accordingly. In Part 2, we detailed the views of new physicians and what their concerns about the current healthcare market involve.


Perspective #3: Rural Healthcare

Rural healthcare is suffering from the effects of the physician-shortage crisis in both the short-term and the long-term. For many communities, the prospect of losing their local hospital is scary, as it will place care at great distance and even greater cost.

Jimmy Lewis, chief executive officer of the Georgia-based rural advocacy network HomeTown Health, LLC, said, “Depending on the source, Georgia is possibly a thousand doctors short right now in the state, and that is heavily impacted in rural communities, because at this stage of the game with that kind of shortage, all of the docs that are graduating can be, if you will, scoffed up by the urban settings.”

Many physicians are reluctant to come to rural Georgia because of the quality of life, he said, where it’s uncommon as opposed to customary to find a Neiman Marcus or a Kohl’s locally. Furthermore, new physicians often find the technology on which they trained in medical school or residency to be lacking.

This is because many veteran physicians are nearing retirement and are reluctant to preoccupy their time with new technology, such as telemedicine and EMRs.

In order to keep and preserve the physicians that are already in the area, many hospitals are forced to buy up the practices that are losing money thanks to lower reimbursements, Lewis said. Hospitals themselves are struggling to stay afloat financially and purchasing a financially unstable practice simply compounds their losses.

As one of Georgia’s healthcare leaders, Lewis is executing a two-pronged strategy to confront the physician-shortage crisis:

1.)     Wherever possible, employ physician assistants and midlevel providers.

Generally speaking, Lewis said, he has found that physician extenders are relatively well-accepted among the physicians at the 56 Georgia hospitals HomeTown Health represents. Where extenders aren’t always accepted is at the state level and in the urban areas where some physicians want to protect their territory.

“And sometimes we’ve seen urbanized protection at the expense of rural Georgia, but when the shortage is so great, it’s just simply going to boil down to supply and demand, and the demand is going to be so great that we will go after whatever supply we can and when it’s not there, we’ll just see a deprived rural community.”

Ironically, he added, a physician-extender shortage is entirely possible in the future, especially given how difficult it is to recruit physicians to a rural community. Some of the best knowledge in rural communities, Lewis said, comes from pharmacists and so-called doc-in-the-box clinics affiliated with such national franchises as Walgreens and CVS. He believes that these places will eventually integrate patient portals and become patient-centered medical homes.

2.)    Integrate telemedicine with the routine delivery of care.

Currently, 51 schools in Georgia have telemedicine. Short of surgery, Lewis said, basically everything a patient needs can be done by way of school-based telemedicine. It takes care of the child, the parent, the employer, and the state employee.

With anywhere from 350 to 400 physicians on the network, the advancement of telemedicine is perhaps most robust in Georgia. Lewis estimated that 150,000 to 200,000 consults are conducted per year using telemedicine.

“The technology is completely proven,” he said. “We’re working now past the acceptance by practitioners and then we’re working through reimbursement… I don’t think there’s any doubt that…probably the most significant new patient-centered medical home is going to be an iPhone, because the delivery of medicine through all of the apps that are even currently there are going to be so exacerbated and increased that the iPhone or Android is going to have total monitoring capabilities. And healthcare of the future is going to be about monitoring, not after-the-fact fixing.”

Furthermore, telemedicine is helping Georgia address mental-health problems that were so prevalent in the state it drew the attention of the Department of Justice. One of the reasons mental-health issues pervaded Georgia was the limited access to psychologists and psychiatrists. Telemedicine is helping them effectively address this issue.

Therefore, the chief advantage of telemedicine, Lewis said, is “we’re able to take skill sets that are urban-centered and make those accessible out in the rural communities.”


Lewis is a vocal critic of the current state of healthcare reform and the way it has been conveyed to the general population.

“All of this stuff about subsidies and premiums and discounts and co-pays, it’s got the user population so confused that what they’re doing where it’s possible, they’re just simply not accessing healthcare.”

And this leads to problems when patients really do need care, he said, but the acuity level of their condition has heightened to the point that they’ve become more expensive to treat.

“As I tell people in the rural communities where a hospital is about to close, ‘Do you want to subsidize your hospital and keep healthcare going or do you want to subsidize garbage pickup?’ That’s one of those priority things that you have to deal with, and interestingly enough, sometimes in rural communities they choose garbage pickup over healthcare, until they close the hospital or they see major physician practices go away. And then suddenly they want them back and it’s too late.”

Lewis believes healthcare reform, as it exists now, is dangerous for rural Georgia, and his outlook on the future is bleak.

“We are about to undergo the most traumatic, draconian transformation of the delivery of healthcare since way back in the beginning when docs rode horseback and did house calls,” he said. “We are seeing healthcare being driven by the insurers. We are seeing policy being abdicated to insurers from the government, and it then becomes entirely a function of critical pathways and engineered health. And access is going to be something that is going to be more valuable than ever because it will become less accessible. And the consequence is, we’re going to have medicine on every corner in urban communities and we are going to have medicine in fewer corners in rural communities.”

-by Pete Fernbaugh

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