Physician assistants and some doctors urge lawmakers to pass bill that could ease provider shortage in rural Kentucky

Doctors and more than 150 physician-assistant students urged lawmakers Tuesday to pass a bill they stated involves dropping only one requirement in the law and could ease a physician shortage in Kentucky, reports Ryan Nick of cn|2's "Pure Politics."

Passage of Senate Bill 43 would repeal a law that allows physician assistants to treat patients only when a supervising physician is on site for the first 18 months after their certification. If passed, PAs would still be supervised but would be permitted to perform services in a location separate from the supervising physician, as long as that physician can be reached by phone at all times.

No other state requires PAs to have 18 months of on-site supervision. Colorado, the state with the next-longest mandate, requires supervision only for the first 1,000 hours after certification.

The bill's supporters say the burdensome supervision requirement has led to 55 out of Kentucky's 120 counties being medically underserved and has encouraged many PAs to practice in other states, reports Storm. They also say this rule needlessly complicates patient care, especially in rural areas where doctors are stretched thin, reports Melinda Beck of The Wall Street Journal.

The bill's sponsor, Sen. Tom Buford, R-Nicholasville, told Kentucky Health News that he expects the Kentucky Medical Association to seek some changes in the bill, but also expects it to pass because Senate Republican leaders, hospitals and universities support it. "We're educating these PAs at a lot of state expense just to work in other states," he said. House Speaker Greg Stumbo, D-Prestonsburg, told Storm he sees no reason why the bill shouldn't pass. Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, told KHN that she supports the bill.

PAs are expected to be in even greater demand when the health-care reform law brings hundreds of thousands of Kentuckians into the health-insurance system. Beck notes the state is expected to face a greater shortage of physicians, particularly in primary care and rural areas. Buford said, "We're going to provide all this health care for everybody, and there's nobody to go see." For more from cn|2, including video interviews, click here.

National Rural Health Day to be celebrated Nov. 15 with free week-long issue-based webinar series

Those almost 60 million Americans who live in rural America do not have as much ready access to health care or to the vast number of health care providers than those who live in more urbanized America. Rural Americans are more likely to arrive on the doorstep of health care facilities without insurance, and that number is growing. These challenges and more have prompted the National Organization of State Offices of Rural Health (NOSORH) to designate Thursday, Nov. 15 as National Rural Health Day. The day, explains NOSORH director Teryl Eisinger, is an effort to increase awareness of rural health-related issues. The event has stretched to a week of activities, celebrations and a daily webinar series on rural health-care issues accessible to anyone interested nationwide.

Here's a schedule of free webinars. All times are Eastern Standard.
Monday, Nov. 12, 3-4 p.m., Basics of Rural Health, with Kristine Sande, program director, Rural Assistance Center; Rebecca David, executive director, National Cooperation of Health Networks; Mike Shimmens, executive director, Rural Recruitment and Retention Network.
Tuesday, Nov. 13, 1-2 p.m., Cultural Awareness While Serving Rural Veterans with Jay H. Shore, MPH, Associate Professor, University of Colorado, Denver.
Wednesday, Nov. 14, 2:30-3:15 p.m., Health Resources and Services Administration Rural Health Update with Mary Wakefield, HRSA administrator.
Thursday, Nov. 15, 3-4 p.m., HRSA's Office of Rural Public Health Policy, Celebrating 25 Years.
Friday, Nov. 16, 3 p.m. Looking Towards the Future of Rural Health Care with Randall Longenecker, MD, Rural Training Track Technical Assistance Program and Jim DeTienne, Montana EMS and Trauma Systems.

All webinars will be recorded and made available to the public at www.celebratepowerofrural.org.(Read more)

Health-care system not ready to deal with baby boomers as they get old, expert says at seminar on aging

When it comes to dealing with aging baby boomers, the nation's health-care system isn't ready to deal with them, Dr. Gregg Warshaw, left, said at the University of Kentucky's Summer Series on Aging in Lexington yesterday. "We've made progress," he said, but "We have a lot more to do, and we are running out of time." (Photo by Jonathan Palmer)

Warshaw's figures show "patients with five or more chronic conditions account for about 68 percent of spending on Medicare," Mike Wynn reports for The Courier-Journal. "Around 141 million people suffered with chronic conditions in 2010, and that number is expected to jump by 30 million in the next two decades."

The shift from primary-care doctors to specialists is another big, expensive problem that is hurting the quality of health care for seniors, Warshaw argued. Ageism and frustrations over health networks are also challenges. "Like a lot of things in American medicine right now, we know the answers to those questions," he said. "We just don't know how to get from here to there."

Warshaw, who is the director of the Geriatric Medicine Program at the University of Cincinnati College of Medicine, was one of more than 350 professionals who attended the seminar, hosted by the UK College of Public Health. (Read more)

Hopkinsville paper examines doctor shortage, reasons for it

Albert Delaney waits for his wife Agnes in Hopkinsville.
(Photo by Kentucky New Era's Tom Kane)

Nick Tabor of the Kentucky New Era examines Christian County's doctor shortage, with the area averaging just one primary care physician for every 2,000 people. It's the latest health story in the small daily newspaper, which is committed to quality health reporting.

The shortage creates problems for residents, who must either travel to another area to see a doctor or go without preventive services because there is no one to see until serious illness occurs. When that happens, that "puts an undue burden" on the local hospital's emergency room.

The shortage is affected by the fact that "primary care physicians, which rural areas need in higher volumers than specialists, are entering the job market at alarmingly low rates," Tabor reports. "More medical students are becoming specialists, as these jobs promise better salaries and hours." Secondly, it is difficult to recruit doctors to rural areas. "Little old Hopkinsville is up against Boston and Chicago and all of these bigger cities," said Teresa Bowers, Jennie Stuart Medical Center's physician recruitment director. "They're not throwing darts at a map and saying, 'I'm going to Hopkinsville.'"

The problem is not a new one. A 2007 report by the Kentucky Institute of Medicine shows there have been shortage issues for decades. "Even if all the barriers that have prevented a sufficient and well-dispersed supply of physicians were suddenly to disappear, the task of recruiting and educating an ample cohort of doctors would take years to accomplish," it reads.

The problem is liken to worsen, however, if the federal health-reform law is upheld by the U.S. Supreme Court, as 30 million more Americans will have insurance to see the doctor. A recent report found medical school enrollment is up by 30 percent, but more residency placements are needed to accommodate the influx. (Read more)

Serious shortage of primary-care physicians expected in Louisville

An aging population, a high number of doctors getting ready to retire, and medical students opting to specialize for better pay and hours are all factors contributing to an expected shortage in primary-care doctors in Louisville.

"By 2020, Jefferson County will need 455 new primary-care doctors — almost as many as the number that work in local medical practices now," reports Patrick Howington for The Courier-Journal. (C-J photo by Matt Stone)

"We see a real workforce crisis in the future — in the immediate future," said Bill Wagner, executive director of Family Health Centers, a group of community clinics that serve low-income residents.

One survey of local physicians found about a third of doctors are 56 or older and are planning to retire within 10 years. Couple that statistic with the fact that the number of American medical-school seniors who entered family-medicine residencies fell from 17 percent in 1997 to 8 percent last year, Association of American Medical Colleges figures show. Part of the reason for the drop is the comparatively low salaries primary care physicians make. On average, they are paid as little as half as much as specialists, such as radiologists and invasive cardiologists.

Though doctor shortages have typically been seen as a rural problem, that's not so anymore. "No matter where you're talking about, we clearly have an aging primary care workforce," because primary care has been "so unpopular," said Dan Varga, chief medical officer of Kentucky's St. Joseph hospitals and a former Louisville internist. (Read more)