Addressing SC's primary care doctor shortage

Greenville NewsFebruary 20, 2014 

THE STATE

Expanding medical residencies in rural and underserved areas of the state is one strategy South Carolina should use to ease the growing shortage of physicians, an advisory group has concluded.

New medical residencies also should be created in primary care fields, the Graduate Medical Education Advisory Group told the state Department of Health and Human Services.

“This is a snapshot of where we are, recognizing the challenges that we’ve got,” state Sen. Thomas Alexander, a member of the group who represents one of the counties designated a health care provider shortage area, told The Greenville News.

“It’s important for us to make sure we have front-line professionals,” said the Oconee County Republican, “especially as we see ... a growing and aging population.”

Like the rest of the country, South Carolina has a shortage of doctors, particularly in primary care.

And with just 77.5 primary care physicians per 100,000 population in 2012 — compared with 90.1 per 100,000 nationwide — the Palmetto State ranked 40th in the number of primary care doctors, according to the Association of American Medical Schools.

Almost every county in the state, or part of it, has been designated a primary care shortage area. Faced with such data, the group was tasked with exploring physician shortages and access to care, the process for funding residency programs, and how the current system fails to meet the state’s health care workforce needs.

Other recommendations include recruiting students from rural areas for pre-med and advanced-practice programs; collaborating with state medical and osteopathic schools to admit and support students more likely to practice in rural areas; and expanding practice opportunities in community settings such as rural health clinics and private physicians’ offices, which have been limited up to now.

The state also should redirect 15 percent of GME funding to support those goals, the group said. South Carolina spent more than $185 million in state and federal Medicaid funds for GME in 2012, the bulk of which went to teaching hospitals, but a physician shortage still exists, they said.

“We are looking at using existing Medicaid dollars to try to enhance rural health care delivery,” Fred Carter, president of Francis Marion University and chairman of the group, told The Greenville News. “We have one county without any physicians whatsoever — Lee County.”

That may mean that hospitals allocate 15 percent into new residencies for family medicine, for example, or into one year of residency in the hospital and the other two at a rural clinic, Carter said. Because residents who spend time in rural settings are more inclined to go back there to practice, he said.

Of the 213 physicians who graduated from medical school in 2010 in South Carolina, 112 attended high school in the state, the group reported. But 95 of them were from urban areas while just 16 were from rural counties.

Dr. Jerry Youkey, dean of the USC School of Medicine Greenville, said he’s encouraged that officials are looking for creative ways to increase the number of primary care physicians and influence the workforce, because more primary care doctors are critically needed in rural areas. That’s one of the reasons the medical school was established in 2012, he said.

“However, I do feel compelled to point out that data from the (AAMC) ... indicates that one in every three practicing physicians in the United States will be retiring within the next 15 years, resulting in a physician shortage of 130,600 by 2025, equally divided between primary care and specialists,” he added.

“It is important to recognize the critical nature of both aspects of the shortage.”

The state ranked 38th nationally in the number of physicians overall, according to AAMC.

The committee included executives from a number of hospitals, including Greenville Health System CEO Michael Riordan, Palmetto Health CEO Charles D. Beaman Jr., and Medical University of South Carolina Medical Center CEO Dr. Patrick Cawley.

DHHS Director Tony Keck said the agency is working on a plan to implement the recommendations.

“The thoughtfulness of the recommendations put South Carolina on the leading edge of national conversations devoted to how we produce more of the doctors and other providers we need who will practice where we need them,” he told The Greenville News.

“This will be a multi-year process, with the recommendations and any newly created programs phased in over time as suggested by the committee.”

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