Health reform said to hurt rural doctor recruitment

Recruiting doctors to rural hospitals will get harder in the next few years as the Patient Protection and Affordable Care Act reaches full implementation and the demand for healthcare services increases, a new report suggests. An Association of Staff Physician Recruiters report, "In-House Physician Recruitment Benchmarking," says interview-to-hire ratios in rural areas are much higher than in urban, and rural recruiting officers are often responsible for several things, not just hiring new doctors, making them overworked. Both factors make it harder for rural hospitals to recruit, the authors concluded. (University of Chicago photo)

ASPR Benchmarking Committee Chair Shelly Tudor told John Commins of HealthLeaders Media that the cost of recruitment is rising, making it hard for rural hospitals to compete with their urban counterparts. "In lots of respects, the process favors urban providers. Physicians are coming to urban areas and they are looking for jobs, whereas rural providers have to go out and target physicians that are likely to come to their area," Tudor said. Rural recruiters have to "filter through a lot of people to find the right one who is willing to come in and even look at the opportunity," she said. (Read more)

Access and cultural issues make alcohol, prescription pills rural drugs of choice

"Alcohol and non-heroin opiates are the drugs of choice in rural populations ... while heroin and cocaine top the list in urban areas, according to a new report from the Substance Abuse and Mental Health Services Administration," reports Aaron Levin of Psychiatric News. Methamphetamine usage was about the same in rural and urban areas, "despite the common assumption that meth is largely a rural problem," Levin writes. Rural people also use slightly more marijuana.

Higher use of alcohol and non-heroin opiates, or prescription painkillers, in rural areas may reflect access issues, SAMHSA's Center for Substance Abuse Treatment director H. Wesley Clark said. "Illegal drugs may be harder to conceal in the pipeline to rural areas, or legal substances may be less stigmatized." Rural people steal about 67 percent of the prescription pills they abuse from friends or family. The rest come from doctors, University of New Mexico psychiatry professor Snehal Bhatt told Levin.

About 67 percent of rural users started using before 18, compared to 53 percent of urban users. This probably leads to higher rates of rural youth binge drinking and driving drunk, according to a University of Southern Maine study. "Rural youth, their families and peers are less likely to disapprove of youth drinking than urban youth, risk factors that are associated with greater likelihood of adolescent alcohol use," researcher John Gale wrote in the study. (Read more)

Rural people more likely to die from colon cancer

Rural people with colon cancer are more likely to be diagnosed late and receive inferior treatment than their urban counterparts, according to a new University of Minnesota study. Rural colon cancer sufferers are also more likely to die from the disease. This is the first study of its kind to show that outcomes in colon cancer are affected by where a person lives, Tiffany Chao reports for ABC News.

The study focussed on more than 100,000 patients diagnosed with colon cancer from 1996 to 2008, with rural people making up 15 percent of the total. Rural patients were 4 percent more likely to get a late diagnosis, had 17 percent lower odds of receiving chemotherapy and had an 18 percent lower chance of getting lymph nodes removed during cancer-removal surgery, indicating that their treatment was most likely inadequate. Overall, rural patients were 5 percent more likely to die from colon cancer. (Read more)

Anti-pill-mill law makes some Ky. doctors stop, or threaten to stop, writing prescriptions

Fighting prescription drug abuse, which has become epidemic in Appalachia and many other rural areas, isn't a simple matter of passing a law. Kentucky, one of the most over-medicated states, is learning that as some doctors are putting up their prescription pads, or threatening to stop prescribing, because they find a new law aimed at "pill mills" to be confusing and overreaching, reports Mike Wynn of The Courier-Journal in Louisville.

"Patients who have never been a problem are bound up in all of this," Greg Hood, Kentucky chapter governor of the American College of Physicians, told Wynn. "There are so many unintended consequences." Hood's group and the Kentucky Medical Association are trying to determine how many clinics are declining to write prescriptions, but neither is advocating that approach. According to state offices of the Drug Enforcement Administration, only three in-state doctors have voluntarily surrendered their DEA registration — required for prescribing controlled substances — in recent weeks for reasons related to the new law. (Read more)

Pennsylvania doctor files suit over gag rule in fracking-chemical disclosure law

A Pennsylvania physician has filed a federal lawsuit claiming that the state's new oil and gas drilling law will force him to violate ethical rules in treating his patients. Kidney specialist Alfonso Rodriguez  argues that if one of his patients was exposed to, and potentially sickened by, fluids used in hydraulic fracturing, the law's confidentiality requirements would compromise his ability to discuss the chemicals with the patient.

His attorney told Sandy Bauers of The Philadelphia Inquirer that Rodriguez frequently treats such patients, including well workers exposed to fluids in a blowout. "He is the doctor fracking-fluid exposees go to," Paul Rossi said. "It's not hypothetical that he's going to need to make use of this law. He may have to go to the gas companies to get information on an ongoing basis." Because of the vagueness of the law, he said, Rodriguez has hired an attorney to draft a letter to his patients notifying them that "his ethical obligation to communicate with them may be curtailed." (Read more)

The suit was filed last week in Scranton. It asks that the medical provisions of the law be suspended until the state drafts regulations to clarify it. The suit names as defendants state Attorney General Linda Kelly, Environmental Protection Secretary Michael Krancer, and Public Utilities Commission Chairman Robert Powelson. 

Health reform's expansion of insurance means doctor shortages are about to get worse

Doctor shortages are most chronic in rural America, but now even places with growing populations like Southern California's Inland Empire are feeling the considerable pinch of not having enough doctors to provide care for a growing number of patients. Thus, some medical crises that face California's Riverside County or suburban Phoenix mirror those found in places like the Mississippi Delta, where there are too few specialists, too few doctors willing to take Medicaid and all are overworked because 9 percent of the nation's doctors take care of 20 percent of the country's population, report Annie Lowrey and Robert Pear of The New York Times. (NYT chart)

The problem is expected to spread under federal health reform, they write. With the expansion of insurance coverage and aging baby boomers driving up demand, "The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. That number will more than double by 2025," Lowrey and Pear report. "Even without the health-care law, the shortfall of doctors in 2025 would still exceed 100,000." In addition, Medicare officials predict their enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year because of the baby boomer demographic hitting their golden years. “Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the medical-college association. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

Medical-school enrollment is increasing, but not as fast as the population. The number of training positions for medical-school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement. (Read more)

Study finds rural health care only a notch behind, with certain advantages over urban care

A new report has found a narrow gap between the quality of health care in rural and urban settings, but the study does recognize the "significant differences" differences between urban and rural care.

The report is an update to "Rural Relevance Under Healthcare Reform: A Tracking Study," by iVantage Health Analytics, and evaluates performance measures across physician, outpatient, hospital and emergency room settings. According to a press release, the report reveals that in Medicare could save about $7.2 billion if costs per patient were the same in rural and urban settings. The report also finds that for rural patients, physician payments are 18 percent lower and hospital payments are 2 percent lower than in urban areas, but outpatient payments are 14 percent higher. The overall cost per Medicare patient is 3.7 percent lower for rural patients.

Rural emergency care is faster overall than urban emergency room care, with rural patients seeing a doctor 30 percent faster (once the patient gets to the hospital, we should add). This results in fewer hospital admissions. The full report can be accessed here.