Millions of people live in medically underserved areas across the US. Doctors and public health officials urge recently graduated medical students to go into primary care residencies that can help assuage this public health crisis. Residencies such as family medicine, internal medicine and pediatrics, particularly in inner city and remote areas of the nation, are most in demand. Fortunately, the U.S. government has extensive online resources to help medical students find exactly which cities and regions need doctors the most.
The UMHS Endeavour looks at this issue and what students at American and Caribbean medical schools can do to help fill the void.
Medically Underserved Areas and Populations
The U.S. Department of Health and Human Services Health Resources Administration (HRSA) website provides a cornucopia of information about Health Professional Shortage Areas (known by the acronym HPSAs) and Medically Underserved Areas and Populations (known by the acronym MUAs/Ps).
- Medically Underserved Areas (MUAs) may be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in which residents have a shortage of personal health services.
- Medically Underserved Populations (MUPs) may include groups of persons who face economic, cultural or linguistic barriers to health care.
- Health Professional Shortage Areas (HRSA) exist when there are 3,500 or more people per primary care physician
As of January 9, 2013, there were approximately 5,900 designated Primary Care HPSAs. Primary Care “HPSAs are based on a physician to population ratio of 1:3, 500,” the HRSA website says. “In other words, when there are 3,500 or more people per primary care physician, an area is eligible to be designated as a primary care HPSA. Applying this formula, it would take approximately 7,550 additional primary care physicians to eliminate the current primary care HPSA designations. While the 1:3,500 ratio has been a long-standing ratio used to identify high need areas, it is important to note that there is no generally accepted ratio of physician to population ratio.”
Primary care needs of a locale, region or district vary by many factors, such as the age of the community's population.
“Additionally, the formula used to designate primary care HPSAs does not take into account the availability of additional primary care services provided by Nurse Practitioners and Physician Assistants in an area,” HRSA’s website says.” Other sources describing primary care supply use other ratios; for example, a ratio of 1 physician to 2,000 population. To meet this ratio, approximately 16,000 more primary care physicians would need to be added to the current supply in HPSAs.”
U.S. States That Are Most Medically Underserved
The Federal Register website says the U.S. Office of Personnel Management (OPM) has completed its annual determination of the states that qualify as Medically Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2014. For calendar year 2013, the following states are considered as Medically Underserved Areas under the FEHB Program:
- New Mexico
- North Dakota
- South Carolina
Physician Shortages in Rural & Inner-City Areas
Rural Physician Shortages
Decades ago, country doctors were a commonplace, but shifting demographics and economics have made them a scarcity in the 21st century. AMSA’s report stresses the need for primary care physicians in rural areas. “Small towns around the country face the loss of their medical services because they have no doctors to run their clinics,” the report says.
(Photo, inset right) Doctors need to be trained to handle health crises unique to urban areas. Photo: FreeDigitalPhotos.net
AMSA says there are fewer rural doctors due to the “increasingly specialized nature of medical practices and the rapid pace of technological advancement.” The report points out that medical schools, “quick to respond to the advancement of science, have done very little to advance the state of medicine in rural communities.”
The American Medical Student Association (AMSA) explains in a report, “Health Care Delivery: Rural vs. Urban Communities, that “more than 20 million people in the United States live in areas that have a shortage of physicians to meet their basic health care needs.”
The AMSA report says medical schools “need to train more efficiently by using partnerships with rural and academic communities. Rural faculty members with rural practice experience and contacts at the rural, state and academic levels need to play a more integral role in maintaining rural residency training programs.”
Inner-City Physician Shortages
As for inner-city sections of major metropolitan areas, the shortage of doctors sounds implausible. However, AMSA cites a report, “Physician Distribution and Health Care Challenges in Rural and Inner-City Areas” by the Council on Graduate Medical Education, explaining why big cities have unique health care problems. “Although urban residents may live close to concentrations of physicians, they do not have access to automobiles and are forced to travel on a crowded bus or on a convoluted urban mass transit system,” the report says.
Women and children in urban areas suffer the most from the lack of inner-city health care.
"In addition to infectious diseases that one commonly associates with underdeveloped rural areas, the urban poor also face health problems that are associated with developed countries: pollutants, accidents, cancer, substance abuse and violence,” the report says. “The urban poor also possess inadequate information about health services and about access to health care services or have too few resources available to them.”
AMSA says decades of focusing development assistance on underserved rural areas have limited the attention given to the big cities with health care crises. “The result is inner-city communities unable to keep pace with rapid urbanization,” the report says.
AMSA cites several problems unique to inner-city areas and health care. Dr. Fitzhugh Mullan, Head Professor of Medicine and Health Policy at George Washington University, worked for decades in inner-city areas of Washington, D.C. He points out the myriad challenges inner-city neighborhoods face. Dr. Mullan says doctors working in these areas must be trained “not only in medical diagnosis but in the realities of the streets and lifestyles of those living in inner-city neighborhoods.”
(Photo, inset right) Inability to pay for medication is a problem in Medically Underserved Areas. Photo: FreeDigitalPhotos.net
The HRSA has a branch, the Bureau of Primary Health Care (BPHC), aimed at helping underserved communities. The BHPC increases “access to comprehensive primary and preventive health care and to improve the health status of underserved and vulnerable populations.”
Online Resources to Get Involved
- American Academy of Family Physicians
- Rural Information Center
- Recovery Act Funding for Health Professions
- National Health Service Corps
(Top photo) Studies say women & children suffer the most in Medically Underserved Areas of the United States. Photo: Sujin Jetkasettakorn/FreeDigitalPhotos.net
Infographic: Scott Harrah/UMHS
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Scott is Director of Digital Content at UMHS and editor of the UMHS Endeavour blog. When he's not writing about UMHS students, faculty, events, public health, alumni and UMHS research, he writes and edits Broadway theater reviews for a website he publishes in New York City, StageZine.com.