College dean: Lack of rural doctors a problem

COLUMBUS -- Rural health care, including the potential impact a universal health care plan could have on rural services, was a focus of discussion during a University of Nebraska Medical Center leadership team visit to Columbus Community Hospital Tuesday.

The UNMC chancellor, deans of colleges and director of the Eppley Cancer Center made brief presentations about new facilities, programs and expansions in place to meet the current and future health care needs of the state.

John Gollan, dean of the College of Medicine, said a primary concern is the lack of primary care physicians, pharmacists and other medical care professionals in rural areas.

Because specialty training and practice routinely pays more than physicians who work at family practices, students are more inclined to receive a few more years of training rather than enter the work force as a family doctor.

This can result in a lack of primary care doctors to meet demand in rural areas, especially for the aging baby boomer generation.

“We’re trying to get more of our students and residents to make their lives in rural areas,” Gollan said.

Dr. Keith Mueller, interim dean of the College of Public Health, said that problem poses a significant obstacle to a universal health care proposal, asking “Do we have sufficient medical personnel?” to meet the demands a universal plan would place on medical care.

Mueller, who focuses on rural health care delivery and finance and has testified before Congressional committees, said “it will do little good if there are no providers,” especially in rural America.

A plan to make insurance available to everyone would place greater demand on primary care, he said, because the low-income and uninsured who received medical attention only in emergencies are likely to receive primary care when insured.

“There is a risk of overwhelming the system,” he said, but one way to resolve the issue is to provide incentives for students to become primary care providers, such as a loan repayment program or filling the pay gap between family physicians and specialists.

Along with the risk is a tremendous amount of opportunity, Mueller said.

Although a public option plan has been presented, he said the same goals could be accomplished without government coverage.

One way is to “require all private insurance carriers to accept all comers,” he said, but private insurance companies have said the only way to remain viable would be for everybody in the U.S. to be legally compelled to buy insurance to help balance risk.

“It’s a pretty dicey question,” Mueller said. “How do we do this in a cost effective way for rural providers? I don’t think there is an empirically correct answer.”

Dr. Harold Maurer, UNMC chancellor, said 50-85 percent of Nebraska’s medical professionals, depending on the region, received their degrees from UNMC and he wanted to thank CCH for assisting in the effort to train and retain the state’s medical professional work force.

“Thank you for all the help you give us in teaching our students,” Maurer said.

Dr. Kyle Meyer detailed the local radiography program implemented in 2007 through a collaborative effort of UNMC, CCH and Central Community College-Columbus (CCC).

Meyer, School of Allied Health Professions associate dean and associate professor of physical therapy education, said the unique partnership program was an effort to meet the radiology service demands in the region and it has exceeded expectations, reporting the first graduate stayed in Columbus and is working at CCH.

“Students interested in radiography can take pre-requisite classes at CCC” and those credits are transferable to the UNMC program, he said. “The majority of students stay here at the hospital and do clinical training at this site.”

“We want to train (students) and move them back to rural communities,” Meyer said, and by doing so, “they are much more likely to stay in those areas.”