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Panel discusses cure for counties without primary care physicians

By   /   July 9, 2012  /   1 Comment

By PHIL DRAKE | Montana Watchdog

Twelve of Montana’s 56 counties do not have a primary care physician, leaving 20,370 of the state’s residents to cross county borders to seek such medical care.

And one possible solution offered for the doctor shortage was: Grow your own.

Members of the Economic Affairs Interim Committee were told at their June 11 meeting that about 2 percent of the state’s population did not have access to primary care physicians within their counties. Twenty-five counties have one to six physicians and nine counties have seven to 20 doctors, according to a chart provided by the state.

Missoula County had the highest number of primary care physicians with 122.

The report by Kristin Juliar, director of the Montana Office of Rural Health and Area Health Education Center (AHEC), noted much of Montana was short on health professionals. The report also stated that health care professionals are retiring at a time when demand by an aging population is increasing. Juliar told Montana Watchdog that communities that do not have physicians usually have either a physician’s assistant or nurse practitioner and said it was likely that residents would have to drive 30-50 miles to the nearest primary care physician.

“I am sure there are some people who would have to drive farther than that,” she said.

The category of primary care doctor, which makes up 22.5 percent of all Montana doctors, includes family medicine, pediatrics and internal medicine, officials said. Of those, 38 percent are female, 62 percent are male and their average age is 50.5.

The 12 counties without a practicing primary care physician are: Carter, Garfield, Golden Valley, Granite, Judith Basin, McCone, Meagher, Musselshell, Petroleum, Powder River, Treasure and Wibaux.

Lawrence White, director of the Western Area Health Education Center, told lawmakers that Montana has professional health care shortages in all but four counties. And the state needs 20 new primary care physicians a year to retain current levels.

He said at two openings per 100,000 residents, Montana is the lowest in the nation for residency slots. Nationwide, the average is 25 per 100,000. Wyoming has seven per 100,000, Alaska has five and Idaho has four.

Montana has one residency program in Billings for eight residents in each of the three years of the program, making for a total of 24 participants. It has an annual budget of about $4 million, the state panel was told. Officials are hoping to start another residency program in Western Montana.

Juliar noted that many of the health care professionals cannot be educated in Montana due to limited enrollments in the Washington, Wyoming, Alaska, Montana and Idaho regional medical program based at the University of Washington Medical School.

Officials are proposing a “grow your own” strategy to ease the problem.

Juliar said one approach was to start helping Montana students interested in the health profession take the courses that will get them into college. And then, if they are interested, tie them into rural Montana communities.

“It is a challenge to recruit into rural Montana,” she said. “It’s a tough practice. If you’re a new nurse you can go to a large hospital and specialize and have nurses mentor you. But if you’re in a rural hospital, you do everything and it can get overwhelming.”

She and other speaking to the Economic Affairs Interim Committee said studies have shown that a high percentage of people in internship programs tend to stay in the communities where they served their internships.

The Billings program has been able to retain 73 percent of the doctors trained and graduated, according to the AHEC.

The discussion also touched on getting good data about the health profession.

“Our concern is we really don’t know who is practicing primary care in Montana,” said Jean Branscum of the Montana Medical Association. She said more data needs to be collected to determine how much time is being spent on primary care and how much time on other kinds of medical practice.

“We all agree the data available is not the best it could be,” she said.

The state panel is expected to discuss the study further at its September meeting.

According to its website, the AHEC was developed by Congress in 1971 to “recruit, train, and retain a health professions work force” for underserved populations. There are 54 AHEC programs nationwide with more than 200 regional centers that work with 120 medical schools and more than 600 allied health programs.

In 2006, the Montana Office of the Commissioner of Higher Education asked the AHEC and Office of Rural Health to look into health care work force issues. The statewide Montana Healthcare Workforce Advisory Committee (MHWAC) was formed to advise the state on how to meet the medical needs of all regions.

A Health­care Workforce Strategic Plan for Montana was unveiled in November 2011.

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  • Margaret Bortko, FNP, EMT-P

    These counties may not have physicians, but it doesn’t mean they are without primary care providers. The rural (and frontier) nurse practitioners and physician assistants are a positive solution to the physician shortage. They are trained to go where the doctor’s do not venture …remote towns and villages in Montana, Alaska and other states. A pap smear is a pap smear, a prostate exam is a prostate exam, managing BP and diabetes, well-child checks, etc are done in the same manner whether a PA, MD, or NP. The rural MD is as limited as the PA or NP in many advanced procedures due to the remote location and lack of back-up and facility ability. A town can get 2 “mid-levels” for the price of one doctor. Study after study demonstrates the cost effectiveness, positive patient outcomes and patient satisfaction with NPs and PAs.