Georgia low on family doctors

By JUNG EUN LEE
http://www.ajc.com

This spring, 385 students graduated from Georgia’s medical schools, but only two of them chose to remain in the state to pursue a family medicine residency. Overall, 20 students, or 5 percent, chose to go into family medicine — half the number that it was just five years ago.

“The decline in the percentage of medical school graduates entering family medicine is cause for concern,” said Kelly McNamara, research and analysis manager at the Georgia Board for Physician Workforce.

“Family medicine physicians often serve as the primary health-care providers in their communities because of their ability to care for patients of all ages and to treat a variety of medical conditions,” McNamara said.

More than one-third, or 58 of 159 counties in the state, many of them rural, are officially designated as primary-care health professional shortage areas. This designation, from the Health Resources and Services Administration, means that, on average, there is less than 1 doctor for 3,500 people. About 1.5 million people in the state are affected by the shortage of doctors.

A recent study from the University of Missouri School of Medicine determined there could be a nationwide shortage of around 44,000 primary-care doctors by the year 2025, due to an aging population and fewer doctors training in primary care.

Currently Georgia needs 259 more doctors in underserved areas to eliminate the official shortage. Ideally, there should be one doctor for every 2,000 people, according to the HRSA. To attain that goal, Georgia would need another 421 doctors.

Dr. Viktoria Nurpeisov recently started her family medicine residency at Atlanta Medical Center after graduating from the Medical College of Georgia in May. As a student, she said she found many specialties interesting. Through the help of school mentors and advisers, however, she decided that family medicine was right for her.

“You take care of the whole population and get to work closely with your patients. You get to know their stories and their names, and they get to know you as their doctor,” Nurpeisov said.

During her training, she will work in Clayton County, in a community where not everyone has a primary-care physician. “They can choose one of us residents as their doctor,” Nurpeisov said. “It’s really rewarding to have patients who put so much trust in you and respect you.”

State residents make up a majority of the medical students in Georgia, but about 70 percent of all graduates leave the state for their residencies.

Residencies, residence

Whether or not medical students stay in the state after graduation is important because doctors typically establish medical practices in the communities where they complete their residencies. Three-fourths of doctors who complete their family medicine residencies in the state usually stay here for at least five years, according to the GBPW.

Nurpeisov said there was no question that she would stay in Georgia after her residency. Her entire family moved to the Atlanta area from Russia in 1999. “My family left everything they had just for me so I could get a better eduation,” she said.

Other graduates find themselves in different situations.

“You could make the argument that we want to keep graduates in the state for residency, but on the other hand, we want students to match in residency programs that are well suited for them, regardless of where they are,” said Dr. Ruth-Marie Fincher, vice dean for academic affairs at MCG, the state’s only public medical school.

Georgia’s newly minted doctors, like their colleagues across the country, are deciding less and less that primary care is right for them. While many chose primary care fields such as internal medicine (22 percent) and pediatrics (15 percent), these doctors will not necessarily end up practicing as generalists. The vast majority of internal medicine residents choose a subspecialty.

The most popular non-primary care specialties this year in Georgia were orthopedic surgery (7 percent) and anesthesiology (6 percent).

“Trends come and go over demand for different residencies, and sometimes that’s out of sync with the demands of the community for health care,” said Dr. D. Douglas Miller, dean of MCG.

Foreigners fill gap

As U.S. medical school graduates have shunned family medicine residencies, international graduates have stepped in to take almost half (40 percent) of them, according to the American Academy of Family Physicians.

This is also true in Georgia.

“We’ve had to learn how to screen international medical school curriculums,” said Dr. Frank Don Diego, program director of the family-medicine residency program at Atlanta Medical Center. “But we’re still producing excellent physicians to practice here in the state.”

This year Atlanta Medical Center interviewed 70 people for its family-medicine residency program. Only four of these students were from Georgia schools, Don Diego said.

“The responsibility for promoting family medicine lies with all stakeholders — medical schools, residency programs, and state and local groups,” said Cherri Tucker, Interim Director of GBPW and the State Medical Education Board.

When it comes to choosing specialties, many students consider what specialties offer in terms of compensation and lifestyle, said Fincher, who advises students during the residency selection process. “This generation of students is more concerned than previous generations about the control they have over their time,” she said.

However, Don Diego said medical schools could do a better job of admitting people who show an interest in going into primary care.

Nationwide, primary-care doctors see twice as many office visits as specialists.

“General practitioners have the lowest incomes of all specialties, and there’s a general perception that they have less control of their hours,” said Dr. Jack Colwill, author of the University of Missouri study.

State incentives

Georgia’s education board runs several programs aimed at alleviating the rural health care shortage, including a loan repayment program. Currently, the average student from MCG who has debt at graduation owes more than $100,000 when he enters residency, Fincher said. Doctors in Georgia can reduce $25,000 of debt each year for up to four years by serving in a county with a population of fewer than 35,000 people.

Georgia’s physician shortage is not limited to rural areas or primary-care specialties. As one of the fastest growing states in the country, Georgia ranks ninth in population but 39th in doctors per capita. The Association of American Medical Colleges has recommended a 30 percent increase in medical school enrollment nationally by the year 2015, to accommodate the country’s growing and aging population.

“If we don’t address this problem quickly, we could soon face a crisis in our health-care system,” Miller said.

MCG, currently located in Augusta, is hoping to add campuses throughout the state. The first expansion, in collaboration with the University of Georgia in Athens, is one year away from accepting its first students, with classes starting before August 2010, Miller said. The new Philadelphia College of Osteopathic Medicine in Gwinnett County will graduate its first class of doctors in the spring of 2010.

The Georgia Legislature this past session recommended a budget increase of $541,461 for family medicine residency programs.

There are also plans to increase the number of residency positions in the state by at least 100 over the next 10 years, Miller said. A summit on the issue will be held at MCG in October.

Three hospitals in Georgia that currently do not have residency programs — Athens Regional Medical Center, St. Mary’s Healthcare System in Athens, and Northeast Georgia Medical Center — are also looking at the possibility of establishing programs that include primary-care specialties.

“The end game is creating a healthier nation with physicians that span the right mix of services,” Miller said.

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