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Health reform at the rural level
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Congressional policy makers may be getting the cart before the horse in their efforts to reform our nation’s health system.

The valiant push to provide health insurance coverage for nearly all U.S. residents is, or will be, woefully undermined by the shortage of physicians to actually treat those who are covered. This is particularly the case when it comes to primary care physicians in rural Georgia.

Georgia has approximately 22 percent fewer primary care physicians per capita than the U.S. average. Ninety percent of Georgia's counties are federally designated as medically underserved and over half are designated as primary health professional shortage areas.

In considering that nearly all stakeholders agree that our health system should be focused on disease prevention and chronic disease management (services associated with primary care providers), it is ironic that the same system actually rewards highly specialized, acute medical treatment (services associated with sub- specialist providers).

It is even more ironic that the same policy leaders who acknowledge this paradox are attempting to reform the system with very little attempt to realign the current incentive structure which aims to emphasize primary care yet rewards for specialization.

Of the most recent graduating class of all five of Georgia's medical schools, only 17 percent ended up in a primary care residency within the state; half of those are in metro Atlanta. Of the current primary care physicians practicing in Georgia, over half are practicing in urban areas, representing only 38 percent of the state's population.

Not only is there a shortage, but they are also unevenly distributed throughout the state, compounding the problem in rural areas.

Although there are many reasons and opinions as to why this problem exists, both suggest that reduced payments and increased administrative workload are significant contributing factors. As for solutions, there are many worth considering:

•Do not reduce state and federal insurance payments to primary care physicians

•Allot additional funding for primary care rural residencies in-state; expand tax incentives for rural practices

•Simplify the operation of a physician's practice by streamlining the insurance claims process

•Offer discounts on malpractice insurance in rural settings

•Expand medical school scholarships and loan forgiveness programs to rural applicants who commit to return to rural practices.

While most Americans agree that the country's health care system needs reform — the argument is how much — it is imperative that national lawmakers consider the national physician shortage before voting for any dramatic overhaul.

The failure to do so could have drastic unintended consequences for everyone.  

Rhett C. Partin is the executive director of the Georgia Hospital Association’s Center for Rural Health.