By Laura Freeman
Does Alabama have too few physicians or not enough of the right kind in the right place? Maybe the answer is both. As in other states, getting an appointment with a primary care physician or specialist within a reasonable time frame can be challenging. So much depends on where you live, how much you can afford to pay, whether you have insurance and if the physician you need is in network or accepts Medicare and Medicaid, or is even accepting new patients.
“We have many rural counties that are underserved,” said Joni Wyatt, MHA, MHIA, CPHIMS, who is a Director of the Healthcare Advisory at Kassouf. “In specialties like women’s health, there are deserts where patients drive a hundred miles to see an obstetrician or gynecologist. At the same time, in other locations near metropolitan centers, in some specialties we have clusters of physician in excess of the number needed for the population. For example, in Birmingham we have 130 more primary care physicians than our population predicts we need. In Athens, we have seven too few, in Oneonta 13 too few, and 17 too few in Pell City. On the other hand, Huntsville, Scottsboro, Decatur and Muscle Shoals have more primary care physicians than their population would predict.”
For practicing physicians, local shortages in some specialties create a referral urgency problem. If, for example, a patient has a creeping calcium level that could turn into kidney damage, it might be dangerous to for a referring physician to wait when appointments for referrals take an excessive amount of time.
Why has the imbalance of physicians in rural and urban areas developed? Physicians tend to live near hospitals where they can train, work and refer patients, and many rural hospitals have closed. Some specialties focus on rare disorders and require a broader population for enough cases to sustain a practice. The biggest factor is probably lifestyle. Physicians often prefer the access to cultural events, services, and interaction with other medical colleagues that a city provides. They want good schools, libraries and activities for their kids and career opportunities for their spouses.
“The 2023 Alabama Physician Workforce Act was passed to help to ease shortages,” Wyatt said. “It streamlines the process and time required to license physicians who move here from other states and countries. It also set up programs for physicians who didn’t match other residency programs. The legislature has also considered expanding the scope of practice for health professionals who can ease the workload for physicians in specific areas of care.”
While getting off to a slow start, the number of nurse practitioners in primary and specialty care in Alabama is now growing rapidly. From near the bottom of the list in number of nurse practitioners, our state is now #3 in fastest growth, with a projected growth of 54 percent in the near future.
“Nurse practitioners and physician assistants are working to extend care which frees physicians to work where they are most needed,” Wyatt said. “There are also technologies that can give a physician more time.”
One area where physicians are overwhelmed is in trying to keep up with new information. “More data is coming in than any one person can read,” Wyatt said. “Physicians want to stay current to give their patients the best care possible. There are services that collect new medical information and organize it summary points physicians can listen to it while they are doing other things. When they want to know more about something they hear, they can look up expanded details.”
“Estimates of how bad the physician shortage will be in ten years vary widely with projections across the U.S. ranging from 13,000 assuming we do all we can starting now to 86,000 if we don’t. One estimate pushes the shortfall to 139,000 if we don’t do more to expand medical education.
“We are losing too many experienced physicians to burnout. Younger physicians coming into medicine have different expectations. They want balance in life and expect to be able to do good work and still have time for family and the things they enjoy. We have to solve the work/life balance to keep physicians and attract more. We need to interest more students in medicine and make the life they can have in that career as attractive as other options.” If doctors come out of school owing as much for their training as the mortgage on a house, it’s hard to pay for both. More scholarships and grants are needed to cover some of the costs.
In order to keep this problem from devolving into a crisis, it will take the best efforts of many people working together to get where we need to be in the next decade.