Georgia ranks 39th in the nation for number of physicians per citizen, and the situation is worsening. The greatest demand is for primary care physicians. They are the first line of defense, responsible for promoting preventive care, finding ways to keep people from getting sick, and thus bringing down costs throughout the system. But a looming shortage of primary care and other physicians could mean more limited access to health care and longer wait times for patients.
Patients want a doctor they can trust. They want their doctors to be competent, to listen, to be empathetic and compassionate, and to communicate effectively. This requires a patient-centered care approach that mandates the physician work with a patient as a partner and often as a decision maker. This leads to long-term relationships that undergird the successful management of chronic conditions. It means communicating at the patient’s level of understanding, a willingness and ability to provide timely and effective relief of pain and the ability to hear what the patient says. This is what primary care physicians do every day.
The reason behind America’s primary care doctor gap is a matter of money. Medical students are graduating with higher debt loads and opt for the highly compensated specialties over primary care. Justified or not, higher pay attracts medical graduates to many procedure-based specialties. Annual income for primary care doctors averages in the mid-$100,000s, less than half of what sub-specialists make. It is easy to see why primary care recruits dropped precipitously and are moving to well-paid sub-specialties.
Mercer School of Medicine is ranked as one of the most successful in the nation at producing physicians that practice in rural and low-income areas and in primary care and family physician shortage areas. Yet it is becoming more difficult to fulfill our school’s mission to provide primary care physicians to Georgia residents. More than 65 percent of our graduates return to a Georgia practice after their residency training and more than 80 percent of those are in medically underserved areas. About 95 percent will remain in Georgia if they also complete their residency training here.
Knowing that it takes seven years to produce a practicing physician, our success begins with the admissions process. The Georgia Board for Physician Workforce monitors physician practice trends and has reported that where students graduated from high school, proximity to family, medical school attendance and location of residency training influence the eventual practice location.
So, our process specifically takes into account the student’s home, starting by only accepting Georgia residents, giving specific preference to those from rural and underserved areas and who state a willingness to return to practice there. Our curriculum specifically exposes students to primary care environments throughout the four-year program. After graduation, we work with local hospitals and communities to connect our graduates with practice sites in the state.
So what else is needed to address this crisis? First, continue the expansion of medical school enrollments. Mercer has almost doubled its enrollment in the past five years by partnering with the state to begin a full four-year Savannah campus. This month we announced the opening of a campus in Columbus for third- and fourth-year students. Georgia also must invest in expanding medical residency training positions at both existing and new sites.
Finally, Georgia must invest in incentives to attract physicians, such as more loan repayment options for those who practice in rural and underserved areas, increased scholarship funding for those who agree to practice in rural and underserved areas and additional tax credits.
William F. Bina III is dean of Mercer University School of Medicine in Macon.
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