First Federally Qualified Health Clinic residency program opens in Kentucky, with hopes of bringing more rural doctors to state

Update, Aug. 8, 2024: Dr. Jerry Eddis has since resigned from the program. 

By Melissa Patrick
Kentucky Health News

Kentucky's first residency program operated by a Federally Qualified Health Center opened July 1 in Northeast Kentucky, with hopes that the resident doctors will set up practice in rural Kentucky after they complete their training. 

The PrimaryPlus Family Medicine Residency Program will be headquartered in Maysville, Ky.  The primary focus of the residency program will be family medicine with plans to use specialty services such as obstetrics and gynecology and pediatrics to provide residents with a well-rounded experience.

Dr. Tyler Elam

Dr. Tyler Elam, director of the residency program, said FQHCs can play an important role in training physicians because of the populations they serve, who are largely indigent, uninsured or underinsured.  

"I think there is a greater . . . mutual benefit for having the learners present in an FQHC," he said. "It helps us close care gaps for the indigent, while also being able to train new physicians."  

Kentucky's program is one of 81 Teaching Health Center Graduate Medical Education programs that operate in 24 states and Washington, D.C., said Elam. 

Research shows that medical students who trained in rural areas are almost twice as likely to practice in rural areas whether or not they grew up in a small town, a topic explored in a blog post from the National Rural Health Association. Further, studies shows that physicians from rural backgrounds were more than twice as likely to practice in a small town, compared to urban counterparts.

And that is the goal of the PrimaryPlus residency program. "That really is part of our mission, is to train them here and keep them here," Elam said. 

There is a great need for rural primary care physicians in Kentucky, according to the 2022 Kentucky Physician Report from the University of Kentucky Center of Excellence in Rural Health. The report says 43 of 120 Kentucky counties meet the criteria for a primary care physician Health Provider Shortage Area. Nearly 73% of of Kentucky's 2,741 primary care physicians practice in urban counties despite the majority of the population living in rural counties.  

PrimaryPlus's residency program will bring four new primary care residents into the state each year.

The first class of residents are Dr. Devaki Dravid and Dr. Jerry Eddis, both from Pennsylvania. Devaki received her medical degree from Philadelphia College of Osteopathic Medicine and Long received his from American University of the Caribbean School of Medicine. Dr. Brion Long is from Breckinridge County, Ky. and Dr. Sara Roberts is from Bath County, Ky. Both Long and Roberts attended the Kentucky College of Osteopathic Medicine at the University of Pikeville. 

Elam said the new residency slots will help to meet the ongoing demand for more primary care physicians, especially as baby boomers continue to need more care.  

"There's not necessarily enough residency spots to keep up with the increasing medical school class sizes. And so, you know, there's like a supply and demand mismatch as a result," he said. "So the more residency spots we can open up, it definitely closes that care gap downstream."

Already, Elam said the resident doctors have been able to close some of the care gaps in the community and have contributed to the wellness of the medical community, who often work short-staffed. 

"The residents are thriving and loving it here," he said. "They'll come to my office and be like, 'Man, this is so great. I didn't know that learning could be like this. I feel like I'm part of the team. I feel like I'm making a difference. And I feel like I'm learning simultaneously.'"

AMA president-elect, from Louisville, lays out his ideas for getting more physicians in rural areas, reforming prior authorization

By Melissa Patrick
Kentucky Health News

With about 46 million people in the U.S. living in rural areas and new research showing they are more likely to die early from the five leading causes of death than their urban counterparts, the American Medical Association is sounding the alarm. 

AMA President-elect Bruce Scott (AMA photo)

"Rural health is America's health," Dr. Bruce Scott of Louisville, AMA president-elect, told reporters in a May 9 press conference in conjunction with the National Rural Health Association annual conference in New Orleans. "We need policymakers to understand that the American Medical Association is deeply concerned about the ever-widening health disparities between urban and rural communities. disparities that are at the root of why rural Americans suffered disproportionately high rates of heart disease, cancer, stroke, respiratory illness, diabetes, and unintentional injuries." 

Scott, who is board-certified in both otolaryngology and facial plastic surgery, served as the Kentucky Medical Association's president in 2018-19. He will become AMA president in June. 

Scott pointed to several environmental, economic and social factors factors that put people who live in rural communities at a higher risk of death from these often preventable conditions. But the AMA's focus, he said, is on the health-care worker and the physician shortage and how this affects rural people's health. 

He added that these shortages are hitting rural areas the largest and are "creating health-care trends that are simply unacceptable. We need to reverse these trends for all individuals to live a long, healthy and active life."

Scott said rural areas have about 30 physician specialists for every 100,000 residents, compared to 236 per 100,000 in urban communities, and he noted that more than 130 rural hospitals closed from 2010 to 2021, with many more on the verge of closing today. 

Also, he said that in 2023, 65% of rural communities had insufficient access to primary-care physicians, including pediatricians. And, he said there are not enough residency spots to train doctors in rural areas. 

"History has shown us that residents, 80% of the time, tend to wind up practicing within 80 miles of where they've done the residency," Scott said. "So residency location becomes very important. In addition, medical schools are receiving fewer and fewer applicants from individuals from rural areas."

Call for Medicare reform

Scott said the AMA is working to build a stronger physician workforce, which he said starts with supporting physicians who are already in practice, to keep them practicing.

"AMA is focused on fixing the systemic issues of our health-care system that are known to be driving physician burnout, and contributing to early retirement and physicians leaving practice altogether," he said. "Highest among these problems are the broken Medicare physician payment system and the administrative burdens." 

The problem, said Scott, is that Medicare payments to doctors are not keeping up with inflation. He said that when adjusted for inflation, the payment rate to physicians has dropped 29% since 2001, and private payers and other insurers have linked their payments to the Medicare structure. 

"We need a system that is sustainable, predictable, and provides at least an annual inflation update that encourages patients choice rather than consolidation," he said. "We need Congress to act." 

Administrative burdens

Scott said physicians spend two hours on administrative work for every one hour with patients, contributing to burnout and hindering patient care. 

A key contributor to this is "prior authorization," which requires a physician to get approval from a third-party payer for care that the physician and patient have agreed on before it can be implemented.  

"On average, physicians complete 45 prior authorizations per week and it's even worse in primary care," Scott said. "The prior authorization process is overused, overly burdensome and wastes physicians' time. But I'm even more concerned about the fact that prior authorization hurts patients." 

He added, "We need Congress and payers and the administration to respond, because the result is that physicians are getting burned out and they're leaving practice, not because they don't want to practice medical care anymore, but because the system is making it more and more difficult for them to care for their patients." 

During the 2024 legislative session, Rep. Kim Moser, R-Taylor Mill, again filed a bill to address the prior authorization issue in Kentucky, but health insurers blocked it. It would have exempted from the process health-care providers who have had 90% or more of their claims approved. 

Scott said the AMA is "fighting for legislation fixes" to increase incentives for physicians to work in rural areas, to expand the number of residency spots, particularly in primary care and in rural areas, to make the pandemic's telehealth flexibilities permanent, and to allow qualified international medical graduates to keep practicing in America. 

Asked about the role of advanced-practice registered nurses and physician assistants to help increase access to care in rural areas, Scott said that "there is absolutely" a role for these "physician extenders" in a physician-led team model. 

"The AMA believes strongly in the concept of a physician-led medical team, where every component of the team is working to the highest level of their knowledge base and their experience," he said. "Now, we're not in favor of independent practice for nurse practitioners or PAs. We think that patients, no matter what ZIP code they happen to live in, deserve care by a physician." 

New UK medical-school graduate plans to pay it forward with a career in rural Kentucky, which needs many more physicians

Dr. Shelley Stiltner (UK photo)

By Melissa Patrick

Kentucky Health News

The University of Kentucky's Rural Physician Leadership Program is designed to increase the number of doctors in rural Kentucky, with graduates like Pike County native Shelley Stiltner.

After earning a UK undergraduate degree in nutrition, Stiltner graduated from the College of Medicine May 13. She is a first-generation college student who attended UK on a full scholarship, which she said she considered not only an investment, but also a thank-you to all of the people who helped her on her way, according to UK Medicine magazine.

Stiltner said she plans to embark on a career in rural medicine, not only to care for patients in need but to help inspire the next generation of rural physicians. 

She added that she worried when she started college and at times, even now, that the stereotype that is often applied to Eastern Kentuckians will overshadow who she is. 

"I spent so much time worrying that being from Eastern Kentucky would be my weakness, but it was my strength all along," she said.

Stiltner said she chose UK for medical school because of its "unwavering dedication to rural medicine" and called her decision to join the Rural Physician Leadership Program "one of the most rewarding decisions of my lifetime." 

" I have gained unmatched experience in rural health care and feel confident in my ability to take what I have learned and truly make a difference in a rural community," she said. "UK saw a grave health care need in rural Kentucky, which I call home, and developed a program to bridge the gap. For that, I am grateful." 

The need for more rural physicians is real and UK's RPLP program appears to be working. 

According to the federal Healthcare Provider Shortage Area tool, every rural county in Kentucky has a shortage of primary health-care providers.

And, according to a January 2020 report on the primary-care workforce shortage compiled by multiple authors at UK, "Kentucky produces and retains only about 55 new PC [primary-care] physicians per year, recruiting 55 to 60 more from out of state. This total of 110-115 new physicians falls short of the 124 PC physicians that must be added annually to avoid worsening our shortage, and far below the 246 PC physicians that Kentucky would need to add each year to reach the U.S. median in the coming decade."

The RPLP program began in 2009 and with this year's class, it has graduated 110 physicians who are well-versed in rural medicine, with their top three residency choices being areas of primary care, Allison Perry of UKnow reported in April. Two of every three RPLP alums are practicing in the state, and 92% of the participants from Kentucky now practice in rural Kentucky.

One is Stiltner. Asked what comes next, she listed several goals such as focusing on women's health, getting involved in providing medication-assisted treatment to women with substance-use disorders during pregnancy, and making an investment in the next generation of rural physicians by serving as a mentor. 

"There is no way I’d be where I am today without the help of mentors along the way," she said. "A promise I made to each of them was that I would pay it forward, and that is a promise I plan to keep. If I can inspire at least one budding rural physician that they have what it takes to make it in medicine, I will consider my career a success."

Stiltner advised future first-generation college students to "proudly be the first" in their family though it will be scary and come with a lot of uncertainty. She encouraged the students to find others who have been first-generation students and to lean on each other in that shared experience. 

"When things get hard, and you feel like giving up," she said, "remind yourself who or what your purpose is in chasing this dream."

UK medical school and recently added regional campuses will graduate largest class ever, with 42% staying in Ky. for residency

Students in this year's graduating class of the University of Kentucky College of Medicine at Lexington celebrated Match Day in March, when they learned their residency locations. (UK photo by Mark Mahan)

By Allison Perry
University of Kentucky

In 2013, the Commonwealth of Kentucky Health Care Workforce Capacity Report announced a grim statistic: by 2025, Kentucky would be facing an estimated shortage of 960 primary-care physicians, the third-greatest shortfall in the U.S.

The physician shortage is not limited to primary care. The greatest physician shortages in the state include surgical subspecialties, psychiatry, and pediatric primary and specialty care. Rural areas have long had physician shortages, and 61 percent of the greatest physician needs in Kentucky are in rural areas.

“The physician shortage in Kentucky is severe,” said Dr. Charles “Chipper” Griffith III,  acting dean of the University of Kentucky College of Medicine. “There are counties without a single physician, and even in parts of Lexington and Louisville, there are areas that are underserved.”

In the past two decades, the UK College of Medicine has gradually increased enrollment, boosting class size from 100 per year in the early 2000s to 136 graduating physicians by the year 2013.

With class sizes at maximum limits due to classroom constrictions and clinical capacity, UK was forced to turn away several hundred qualified Kentucky applicants to medical school every year, but the College of Medicine and UK HealthCare have worked with other Kentucky clinical partners and other state universities to create opportunities for more Kentucky medical students through regional medical campuses.

The goal is to increase the number of physicians who will stay in Kentucky to practice medicine, expresed as “training Kentuckians in Kentucky to practice in Kentucky,” 

This year, across all four sites of the UK College of Medicine – Lexington, Morehead, Bowling Green, and Northern Kentucky – a record-setting class of 190 medical students are set to graduate and begin practicing medicine.

All combined, these campuses will be able to graduate up to 201 new physicians each year, with a total enrollment of up to 804.

A banner Match Day for Kentucky

Match Day is a longstanding medical-school tradition, a nationwide event where medical students learn where they have matched for their residencies following graduation. The national initial match rate for medical students is roughly 92%, and UK’s rate has historically been higher. This year’s rate, with the largest-ever class of graduating medical students, is 97%. 

But even more important is the match rate of students remaining in Kentucky, Griffith says. Historically, 25 to 30% of UK medical students matched to a residency in Kentucky. That number began growing in 2019, and this year, 42% of UK graduates will be staying in state to begin practicing medicine as a resident. Since 2017, UK has more than doubled the number of new physicians remaining in the state.

With UK’s largest graduating class matching in Kentucky at the school’s highest rate, this bodes well for reducing the physician gap.

“The biggest factor for a physician practicing in Kentucky is both going to medical school and doing a residency in Kentucky,” Griffith said. “Nearly nine of 10 physicians who do both will remain in state to practice when residency is finished.”

With this in mind, UK has placed more emphasis on enrolling in-state students – in recent decades, roughly 70-75% of medical students were from Kentucky, and the goal now is for 85% of each medical class to be a Kentuckian or have a tie to the state.

The Rural Physician Leadership Program

UK's regional approach began with the Rural Physician Leadership Program, developed with Morehead State University and the Morehead hospital, St. Claire HealthCare. The program was developed to train students who are interested in practicing rural medicine after graduating, and the program has capacity for up to 12 students per year.

RPLP students complete their first two years of education on UK’s main campus in Lexington and spend years three and four in Morehead, rotating through St. Claire and other rural clinical sites in the area.

The program began in 2009. With this year’s class, the RPLP will have graduated 110 physicians well-versed in rural medicine, with their top three residency choices being areas of primary care.

Two of every three RPLP alums are practicing in the state, and 92% of the participants from Kentucky now practice in rural Kentucky.

“The premise behind this program works,” said Dr. Rebecca Todd, associate dean for the RPLP and an obstetrician-gynecologist at the UK HealthCare Morehead Women’s Health Clinic at St. Claire. “It’s hard to transplant someone who is used to – and who loves – an urban area into a rural area. But if you take students from rural communities and train them to be physicians, they want to go back and practice in those rural communities.”

Having the opportunity to live and train in a smaller community allows RPLP students to have more one-on-one time with the physicians they’re learning from, almost like an apprenticeship, Todd says. Students get the advantage of closer mentorship coupled with UK’s rigorous curriculum to prepare them for their careers in medicine.

“When you work with regional campuses, you get both the resources from the larger institution, like UK, but you also have that smaller, close-knit feel,” Todd said. “I think this program really brings out the best in all medical training.”

The UK College of Medicine-Bowling Green campus

In 2018, UK took another huge step in growing its class size by partnering with Western Kentucky University and Med Center Health of Bowling Green, which operates six hospitals and more than 30 clinics in Southern Kentucky. Students complete their classwork and clinical experience in Bowling Green, primarily at The Medical Center at Bowling Green, the system's main hospital.

“We’re meeting the mission,” said Dr. Todd Cheever, a UK associate professor of psychiatry and the associate dean of the Bowling Green campus. “Having students from this region, where they can train close to their families and support systems, is very important.”

Adding this regional campus has enabled UK to train up to 30 more future doctors each year. This year, the Bowling Green campus will graduate its second class, and seven graduates will stay in Bowling Green for residency.

Nearly half of the Bowling Green campus’s two graduating classes matched into primary-care residencies, and 27 matched into Kentucky health systems.

The UK College of Medicine-Northern Kentucky campus

UK’s most recent regional campus, a partnership with Northern Kentucky University and St. Elizabeth Healthcare, will graduate its first class next month.

This campus has an annual capacity of 35 students, who complete coursework and clinical experience in Northern Kentucky. More than 90% of the students are from Kentucky or nearby counties in southwestern Ohio.

Seven of this year’s inaugural class of 30 graduates will remain in Kentucky for residency, while eight will be working at health-care facilities just across the river in Ohio. Five graduates from across all UK College of Medicine sites will go into residency at St. Elizabeth Healthcare.

Looking toward future growth

Griffith offers some simple math to demonstrate the importance of graduating new doctors: If UK graduates 65 more doctors a year than in the recent past, history shows that roughly half – around 33 – will eventually practice in Kentucky. And if the average physician takes care of roughly 5,000 patients in their lifetime, that could be an additional 165,000 patients in Kentucky each year that now have access to a physician compared to past years, he says.

The regional campuses have room for growth, and UK's Lexington medical campus is growing, too. A Health Education Building now being designed, combined with expansion of UK HealthCare’s clinical services, means that the College of Medicine could add 50 to 65 new students per class in Lexington. By the end of the decade, UK could be graduating nearly 280 new doctors each year – more than double the number who graduated in 2021.

Growing class size also means the need for more teachers, but the response from faculty at the regional campuses, has been overwhelmingly positive. The presence of a medical school has helped Med Center Health and St. Elizabeth Healthcare recruit new physicians, and alumni from UK have been particularly energized and engaged.

“A lot of these physicians didn’t plan on being teaching physicians, but they’ve found that it’s invigorating,” Griffith said. “They really enjoy it, and they’re ready to have more students.”

Doctor shortages persist in rural America, including Kentucky, and medical residency programs are scarce in rural areas

Centre for Economic Policy Research image

One of the best ways to increase the number of doctors in rural areas is to provide medical residency training there. Kentucky has seen a concerted effort to expand rural residency programs, but their number remains relatively small in the state and nation.

"Experts say expanding the number of medical residency training programs in rural areas is key to filling gaps in care because many doctors — including more than half of family medicine physicians — settle within 100 miles of where they train," Jazmin Orozco Rodriguez reports for KFF Health News. "And while the number of training programs has increased in rural areas during the past few years, research shows 98% of residencies nationwide are in urban areas."

In Kentucky, fewer than 20 of the state's 154 accredited residency programs, listed by specialty, are outside Lexington and Louisville. Seven of them are for family medicine and can be found in Somerset, Owensboro, Edgewood, Hazard, Glasgow, Madisonville and Morehead.  

Rodriguez tells the story of a residency training program in rural northeastern Nevada that is preparing to close, where one resident physician said she must now leave a program that she chose because she knew she would be filling a need and the patients under the care of the residents must now seek care elsewhere, often in emergency departments, 

The program, established in 2017, is shutting for a variety of reasons, including financial struggles, lack of a united support system, and a historical lack of health-care investment in the area, Rodrigue reports. 

The closure of such programs in rural areas only adds to the problem of accessing primary care, which Rodriguez reports impacts more than 100 million people in the U.S., a number that has nearly doubled since 2014.  Further, she writes that provider shortages only got worse during the pandemic, especially in rural areas, which have long struggled to recruit and retain doctors and other health professionals. 

According to the Healthcare Provider Shortage Area tool, every rural county in Kentucky has a shortage of primary health-care providers. 

And, according to a January 2020 report on the primary care workforce shortage compiled by multiple authors by the University of Kentucky, "Kentucky produces and retains only about 55 new PC physicians per year, recruiting 55 to 60 more from out of state. This total of 110 – 115 new physicians falls short of the 124 PC physicians that must be added annually to avoid worsening our shortage, and far below the 246 PC physicians that Kentucky would need to add each year to reach the US median in the coming decade."

Members of Congress have introduced bills to address the health care provider shortage, but to no avail. Meanwhile,  rural medical training programs need more state and federal investment to grow and remain sustainable, Dr. Emily Hawes, associate professor at the University of North Carolina-Chapel Hill School of Medicine, told Rodriguez. 

A federal law fully implemented in 2019 creates more flexibility in funding and accreditation for rural hospitals wanting to establish residency programs. It has sent more than $43 million to 58 organizations in 32 states to state rural residency programs. "As of last fall, the recipients had created 32 accredited training programs in family medicine, internal medicine, psychiatry, and general surgery, and received approval for more than 400 new residency positions in rural areas," reports Rodriguez. 

But it’s not enough, Hawes said. She said a big challenge is that Medicare and Medicaid don't reimburse rural hospitals for residency programs at the same rate they do urban hospitals, despite similar or higher costs. 

Kentucky has passed legislation toward improving the health care workforce in the state. In the most recent legislative session, a bill passed to create the Health Care Workforce Investment Fund, which would use private and public money to increase scholarship opportunities.  Also, a bill to let advanced practice registered nurses prescribe controlled substances on their own after four years passed, which is expected to increase health care access in rural parts of the state.

Most Kentucky counties don't have enough primary-care doctors

Kentucky Department for Public Health map, adapted by Kentucky Health News

Most of Kentucky's rural counties and some of its metropolitan areas have too few primary-care doctors and they are leaving faster than they can be replaced, Sarah Ladd reports for the Louisville Courier Journal. All told, 94 percent of the counties in a state with poor health outcomes don't have enough doctors. 

"Experts say primary-care doctors can help people get ahead of health problems before they turn into emergencies, and the shortage is exacerbating problems in a state that already ranks high in the nation for diabetes deaths, heart disease, obesity and cancer, among other things," Ladd reports. 

Reasons given for the shortfall are myriad, including the pandemic causing more retirements, doctors choosing higher paying specialty fields instead of primary care, and medical-school graduates going to other states.

Experts told Ladd that part of the solution is investing in educating physicians in and from the underserved areas.

"We're trending in a dangerous direction here if we don't have a big intervention soon," Ashley Gibson, director of workforce development with the Kentucky Primary Care Association, told Ladd. One solution, she and Molly Lewis, interim CEO of the association, offered is creating pipelines to get Kentuckians educated in health professions and then back to working in their own communities.

Lewis told Ladd that ideally 100% of Kentuckians would have a personal primary care doctor, but Ladd reports that CDC data shows that only about 74% of them said they did in 2020. 

Having a personal physician makes it more likely you will seek preventive care, be up to date on your care, be healthier overall healthier spend less money on health care, Lewis told Ladd: "If . . . you're creating access to primary health care, then you are reducing the need for more expensive types of health care services because you're able to diagnose, treat and prevent poor health outcomes."

Gibson said 40% of Kentuckians live in rural areas, but only 17% of the state's primary care doctors practice in those places.

Kentucky had 58 primary-care doctors per 100,000 residents in 2019, ranking it 45th in the nation, according to the American Academy of Family Physicians. Lewis noted University of Kentucky research that found the state ranked 44th in 2021, a bit better than 2019 but lower than its 2016 ranking of 40th. 

"Federal data show Kentucky had only 418 more primary care doctors in 2016 − the latest year for which such information is available − than it did in 1999, and repeatedly has had less than many of its neighboring states," Ladd notes. 

The problem is national. In 2020, the Association of American Medical Colleges predicted that by 2033, the nation would be short between 21,400 and 55,200 primary-care physicians.

In Kentucky,  a UK report said the state needs to add 237 physicians every year, which outpaces its estimated annual influx of 116, to hit the national median by 2025. 

Meeting this goal will be difficult, Gibson told Ladd, because more than half of Kentucky's medical school graduates leave the state to work. Lewis "said it could have something to do with students being from other states and moving to Kentucky only for their education," Ladd reports.

UK College of Medicine’s Bowling Green Campus welcomes inaugural class, with hopes they will stay in the region to practice

Students of the UK medical school’s Bowling Green Campus
pose in front of Western Kentucky University’s Van Meter Hall.

The University of Kentucky College of Medicine’s Bowling Green Campus welcomed its first class of 30 medical students Aug. 3 during its inaugural white- coat ceremony at Western Kentucky University, Don Sergent reports for the Bowling Green Daily News.

This four-year, regional-campus medical school is the first of its kind in Kentucky. It was created through a partnership between UK, WKU and The Medical Center at Bowling Green in an effort to bring more doctors to the region.

A UK news release notes that the Bowling Green campus is a fully functioning campus, utilizing the exact curriculum and assessments as UK’s Lexington campus.

The 24,000-square-foot portion of the $28.3 million building on The Medical Center's campus where the students will eventually be located won't be ready until mid-September, so they will begin the program using facilities at The Medical Center and WKU, Sergent reports.

At the ceremony, Don Brown, assistant dean of the Bowling Green campus, bragged on inaugural class members for their many accomplishments and told the attendees that the selection process was highly competitive; and Associate Dean Todd Cheever said the class fit well with their goal of addressing the need for more physicians in Kentucky, Sergent reports.

“The vast majority of the students are from Kentucky, which is the mission,” Cheever said. “And the ones from out of state have Kentucky ties. I believe we have the right 30 students.”

Of the 30 new students, 26 are from Kentucky, representing 14 Kentucky counties, including five from Bowling Green or elsewhere in Warren County. The others are from Ohio, Tennessee and Florida.

Mallory Vaughn, a WKU graduate who has known since elementary school that she wanted to be a doctor, told Sergent that the Bowling Green campus “was an absolute dream for me. I get to work in the hospital I was born in. I’ll be able to prepare for my professional career and give back to the community that has nurtured me.”

Connor Donley, also from Bowling Green, told Sergent that he was ecstatic when he was selected for the inaugural class. “The timing couldn’t have been more perfect for me personally,” said Donley, a UK graduate. “I’m excited that I’m going to be getting my education in the community where I grew up.”

Earlier the same day, 136 students received white coats in a ceremony at the UK College of Medicine's Lexington campus.

A similar regional program is expected to open in Northern Kentucky in the fall of 2019, through a partnership between UK's medical school, St. Elizabeth Healthcare and Northern Kentucky University. It will have 35 students in its inaugural class. UK's medical school also partners with Morehead State University and St. Claire Regional Medical Center to offer the Rural Physician Leadership Program.

All of these programs aim to bring more physicians into the rural parts of the state.

43% of Ky. medical-school students become primary-care physicians; nationwide, the figure is only 20 percent

Kentucky seems to be dealing with the shortage of primary care physicians more effectively than the rest of the nation, but it's still uncertain if the state's efforts will be enough.

The problem is that fewer medical students are choosing to go into primary care. With the average medical student graduating with $200,000 or more in debt, many opt for higher-paying specialties, Sam Dick reports for Lexington's WKYT-TV. To make matters worse, older family physicians are retiring or dying and more patients are getting older and sicker.

In the next seven years, the United States will need 52,000 more family doctors and Kentucky will need about 1,400 more -- mostly in rural areas, Dick reports.

"You know, we're seeing a lot of health-care providers that are just burned out," Lexington Clinic physician recruiter Robert Bratton told Dick. "They're being asked to do more and more, in less and less amounts of time, and it's very difficult. . . . It's staggering. It really is. "

Dr. Hoellein, associate dean for student affairs at the University of Kentucky College of Medicine, told Dick that Kentucky is bucking this trend. He said that nationally 20 percent of medical school students choose primary care, but in Kentucky that number is up to 43 percent.

Toward that end, the UK medical school is expanding across the state. A two-year school is open at St. Claire Medical Center in Morehead, UK's Bowling Green campus opens this summer, and next summer UK Northern Kentucky will start taking medical students. The hope is that new, primary care doctors will train in those areas of the state and then remain in them to practice medicine.

Dick notes that physician assistants are helping to pick up some of the patient load, but Dr. Michael Eden, an "older family doctor," said, "Even at this point with them helping us out, we struggle some days to get everyone in."

Nurse practitioners ease doctor shortage, but will have to wait to get more authority to prescribe narcotics; opioid epidemic cited

Nurse practitioner Robin Szczapinski talks with her patient, 

Harold Brashear Sr., at the Louisville Veterans Affairs Medical

Center. (Courier-Journal photo by Maggie Huber)

They're not doctors, but they do a lot of the same things, probably most things most patients need. They're nurse practitioners, officially known as advanced practice registered nurses, or APRNs. Kentucky has 5,400 of them, and they are helping ease the state's shortage of doctors, reports Darla Carter of The Courier-Journal.

“Since the expansion of the Affordable Care Act, there’s been an increased need for primary care providers and there’s just not enough physicians within the state of Kentucky,” Lewis Perkins, a geriatric nurse practitioner and chief nursing officer at Louisville's Norton Hospital, told Carter.

Nurse practitioners in Kentucky must have a collaborative agreement with a physician to prescribe narcotics and some other controlled substances, and for the first four years of prescribing, other drugs. They would like those restrictions removed, and a bill in the legislature would do that.

The sponsor of Senate Bill 158, Sen. Paul Hornback, R-Shelbyville, told Carter he introduced the bill only to get discussion started. It did, at least for people whom Carter contacted.

Dr. William C. Thornbury, president of the Kentucky Academy of Family Physicians, sent Carter a statement saying the bill "conflicts with our governor's policy to combat opioid abuse. Removing the collaborative agreement between a physician and an APRN eliminates the consultation process, which is an important protection in place that helps curb the abuse that is ravaging our commonwealth.” The Kentucky Medical Association also opposes the bill, citing similar reasons.

Wendy Fletcher, a "doctorally-trained nurse practitioner" and president of the Kentucky Coalition of Nurse Practitioners & Nurse Midwives, "noted that nurse practitioners are monitored through the U.S. Drug Enforcement Administration and the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system – just as physicians are – and are held to a high standard by the Kentucky Board of Nursing," Carter reports.

UK medical school says it will establish satellite in Bowling Green, expand Morehead program, add Ashland hospital to it

Citing doctor shortages in rural areas, the University of Kentucky is starting a satellite medical school in Bowling Green and expanding its medical-education program in Morehead.

UK will partner with Western Kentucky University and The Medical Center at Bowling Green and continue its collaboration with Morehead State University and St. Claire Regional Medical Center, UK President Eli Capilouto announced Thursday. The Morehead program will expand to include King's Daughters Hospital in Ashland.

"The Commonwealth of Kentucky has a shortage of physicians, and especially primary care physicians, throughout the state, but particularly in rural areas," Capilouto said. "This is an acute health-care need and an economic one as well."

The university said in a news release, "The UK College of Medicine is at its capacity at the Lexington campus and although there is a deep applicant pool for medical students, the college can’t expand enrollment without the help of regional partners."

UK has 521 medical students, 139 in its most recent class. The satellite programs, which will focus on the early part of medical education, will increase enrollment by about 30 percent. For several years, UK and Morehead have had a program in which 32 students have completed their "third and fourth years of medical training with rural-centered clinical experiences primarily at St. Claire," the release noted. That will now expand to the Ashland hospital.

The new programs could start as early as 2018. details are still being worked out, the release said.

Laura Ungar of The Courier-Journal notes, "A 2013 study by Deloitte Consulting found the state needed 3,790 more doctors, including 183 additional primary-care physicians, to meet demand even before the Affordable Care Act. Kentucky currently has 9,936 active physicians, according to the Association of American Medical Colleges, or AAMC. That works out to 225.1 active physicians per 100,000 people in 2014, ranking the state 36th in the nation."

"These shortages reflect a national issue," Ungar notes. "AAMC expects the nation will face a shortage of 46,000 to 90,000 doctors by 2025 – even as the U.S. population grows by 31 million and the number of Americans over 65 goes up 46 percent. Compounding matters, more than a quarter of active physicians nationally are 60 or older and likely to retire soon. Seeing these trends, the association in 2006 called for expanding the number of medical school graduates by 30 percent. A January report in The American Journal of the Medical Sciences said medical schools have so far increased enrollment by 23 percent."

Panel of physicians at national conference discuss future of rural primary care, how to solve doctor shortages

More needs to be done to address the shortage of primary-care physicians, a big problem in rural areas and much of Kentucky, according to a panel of physicians at "Rural Health Journalism 2014," Kris Hickman writes for the Association of Health Care Journalists, which sponsored the conference.

Almost half of rural U.S. counties, 44 percent, struggle with primary care physician shortages, said Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care of the American Academy of Family Physicians. According to a presentation at the 2013 Kentucky Rural Medical Educators Conference, Kentucky had a 1,287:1 primary care physician to citizen ratio, which is 557 short of the national average.

The national shortage is expected to worsen soon because almost 27 percent of those providers are older than 60, said Mark A. Richardson, M.D., dean of Oregon Health and Science's School of Medicine.

Bazemore said the medical community needs to draw more attention to the need for more primary care physicians in rural areas. He also said that for every dollar spent on health care, only six or seven cents are spent on primary care. "States facing a shortage should remember that primary care is the logical basis of any health care system," Bazemore said.

Richardson recommended that medical schools try to recruit students who have rural backgrounds because they're more likely to return to practice in rural areas. He and Bazemore agree that students who practice in rural areas should be given loan forgiveness or scholarships. "Debt prevents many people from choosing primary care," Bazemore said.

Richardson said the most important factor for where medical students end up practicing is where they completed their training. "Rural training is one of the highest predictors of a rural practice and should be required," he said. To do this, the government-imposed cap on graduate medical education spending would have to be abolished.

"Medical care is not a free market dynamic," Richardson said. "We pay for health care transactions, rather than health." (Read more)

Community paramedics program could help provide primary-care services, help address state's provider shortage

Next spring, the Kentucky Board of Emergency Medical Services could establish a community paramedics pilot program that has the potential to ease the state's shortage pf primary-care health providers.

The idea was prompted by the likelihood that the state's expansion of the Medicaid program would lead to a shortage of primary-care personnel. It would add community paramedics to a local health care delivery system, reports Chuck Mason of the Bowling Green Daily News.

“We’re in the first stages of looking into this,” Michael Poynter, executive director of the EMS board, told Mason. “Vulnerable populations with new health insurance plans will not have access to a provider because of the increase in demand.” The provider shortage, particularly in rural areas, especially affects those without to transportation, said Poynter.

Under the program, a primary-care partner could refer a patient to EMS personnel to provide services such as fall prevention, blood draws or medication administration, in the patient’s home. The paramedic would provide documentation to the patient’s primary care physician.

The program has the potential to allow paramedics to play a more active role in care delivery, changing the face of emergency medical services, writes Mason. "The big question at this point is how health care providers would receive reimbursement from the government for expenses related to community paramedics and how the concept would integrate into the health care systems already in place in Kentucky," Poynter told Mason.

Some say such a program could reduce overall health care costs, reports Mason. It could even help reduce hospital re-admissions, potentially saving them millions of dollars because federal health reform penalizes them for re-admissions.

EMS personnel "have the training, expertise and scope of practice to provide essential primary care services," Poynter told Mason. He said such programs have been successful in Colorado, Minnesota and Pennsylvania, where paramedics are practicing community medicine after completing a training program.

Kentucky's training could be provided by colleges and universities, Mason writes. Western Kentucky University is exploring coursework for emerging jobs in the health care field. "Patient education, teaching about healthy best practices and health care screening could be some of the roles filled by the community paramedic," Poynter told Mason. "The idea is not to replace home health or physician office visits, but rather to augment the health care." (Read more)

Rural doctors need to support recruitment of more colleagues, former Leitchfield hospital administrator writes

With Kentucky's doctor shortage about to be exacerbated by expansion of the Medicaid program and federally subsidized health insurance, there will be more competition than ever to recruit physicians, especially to rural communities. Some doctors resist such recruitment, but they are short-sighted, writes Stephen Meredith, former chief executive officer of Twin Lakes Regional Medical Center in Leitchfield.

Twin Lakes Regional Medical Center

"When I became CEO of TLRMC in 1983 our local hospital had seven doctors on its medical staff, so the first order of business was the recruitment of additional physicians, or so I thought. When this idea was presented to the collective medical staff it with was met with a resounding 'NO.' The medical staff’s concern was recruitment would hurt them financially by further 'dividing the pie' of a finite number of patients," Meredith writes for The Record in Leitchfield.

But many more doctors were recruited (now more than 30), and the old doctors realized it was a good thing, Meredith writes: "Two of the more vocal physicians against recruitment later acknowledged the addition of more physicians, especially specialists, made their own practices even busier than before. In defense of these men, they were so busy seeing patients in their practices, they had to believe they were seeing everyone who possibly needed medical care. However, they had no idea how many people were leaving our community for health care because of the shortage of physicians."

The phenomenon extends to other lines of work, Meredith notes: "What occurred within our medical community was recognized and theorized by John Nash as the theory of economic equilibrium for which he won the 1994 Nobel Prize in economics. His theory, in essence, is when we all work together for everyone’s mutual benefit rather than just our own, in the long-run, everyone benefits by expanding the 'size of the pie.' No one wins when it comes at the expense of others, but everyone wins when we take a broader view of our community and purposefully commit to pursuing initiatives which leave no one behind. After all, we are all in this together." (Read more)

Hospital and insurance chiefs say health reform will improve Ky.'s health care and its health, after bumps in road

By Al Cross
Kentucky Health News

The federal health-reform law will improve health care and help make Kentuckians healthier, though some will be inconvenienced, officials of Kentucky's leading hospitals and the Humana Inc. insurance company said Tuesday at the Kentucky Chamber of Commerce's annual Business Summit.

Brinkley

"We have the ability to move the needle, and we will move the needle," Kentucky One Health CEO Ruth Brinkley said after citing the state's dismal health statistics. She was one of four hospital chiefs on a panel that concluded the meeting in Louisville.

Dr. Michael Karpf, head of UK HealthCare, said "More people will be insured, we'll do things better and we'll focus on the right things. . . .You've just got to buckle up for the ride."

Williams

Norton Healthcare President and CEO Stephen Williams said Kentucky has some of the best health care in a nation that has the best health care in the world, but the state's health status is low and the U.S. ranks only in the middle among industrialized nations, though it pays more for health care than any other country. A fundamental reason for the state's poor health, he said, is lack of access to health care.

Broussard

At an earlier session, in response to a question about the Patient Protection and Affordable Care Act, Humana President and CEO Michael Broussard said, "Having access and people covered is the right thing to do. When people have the ability to go get health care, they're going to be healthier."

Brinkley there are some things in the law that she does not like, but she didn't name them, and said her organization was "very encouraged" by Gov. Steve Beshear's expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. "It will offer an accessible system to the people who need it most," she said, adding, "None of us will do well if the vulnerable remain vulnerable."

While no one on the panel or the audience raised the prospect that the law would be repealed, as House Republicans have voted to do dozens of times, there were no suggestions that repeal is a possibility. Broussard said of the law, "It's here to stay."

Earlier, he said implementation of the law "will create some disruptions" but also "some really neat changes," as the country changes to a true "health care" system, from the current "sick care."

Karpf

The reform law is making hospitals change their approach from a fee-for-service system, which rewards them for more and longer admissions and procedures, "to something that rewards outcomes," Karpf said.

"We are paid to do the wrong things," Williams said. The current system "basically rewards more volume, whether it's needed or not. . . .We're volume-based rather than value-based," which the new system is supposed to be.

Hospitals have not been at the forefront of helping people be healthier and avoid hospital stays, but need to do more of that, said Steve Hanson, CEO of Baptist Health. "It's the right thing to do." He said one his company's stated missions is to enhance health, "which we don't talk nearly enough about, and we do even less."

Brinkley said she worries that there won't be enough health-care providers to handle the people who are joining the health-care system, but she said the law will decrease use of hospital emergency rooms, and "that will be good for all of us."

Hanson

"We have got to keep people out of our emergency departments," said Hanson, whose company owns or manages 10 Kentucky hospitals. "That's the most expensive place . . . and it's still not the best care."

Hanson said President Obama's delay of the employer mandate (actually the requirement for employers to report on their health insurance to the Internal Revenue Service) would not be the last delay in the implementation process, because the law is so complex. Brinkley said she would not be surprised to see other parts delayed.

Among patients, "There will be some disappointments and concerns," Karpf predicted, noting that some won't be able to keep their doctor if he or she is not in the network of the health plan they choose, contrary to promises made by the law's advocates. "Once you sign up for a plan you may not have much of a choice of a doctor."

Also, Karpf said, the process of buying insurance through the online exchanges may be daunting for people who have never bought a health-insurance policy. For example, he said, they may not realize that they are buying a policy with high deductibles.

And, agreeing with some of the law's critics, Karpf said many people may lose their employer-provided insurance because their employers will choose to drop coverage for employees and pay the relatively modest penalty for not insuring them.

Broussard said the implementation problems will work themselves out, but "We'll be talking about this for the next decade."

As health care expands and more providers are needed, pressure grows to allow nurse practitioners more prescribing authority

By Molly Burchett
Kentucky Health News

As Kentucky expands Medicaid and implements the Affordable Care Act, more Kentuckians will have health coverage and access to care, worsening Kentucky's already existing shortage of physicians, particularly those providing primary care in rural areas. And, as the stakes get higher, so do tensions between physicians and nurse practitioners about how newly covered Kentuckians will receive their care.

Nurse practitioners say part of the solution involves removing their requirement to have a "collaborative agreement" with a doctor to write prescriptions. Nurse practitioners have been pushing for years to get rid of this requirement, saying they have the expertise to independently prescribe non-scheduled or routine drugs like cholesterol medications, reports Laura Ungar of The Courier-Journal in an article about the NPs' debate with physicians.

Doctors say collaborative agreements are necessary to protect patients, and call for a team-based approach to health care, writes Ungar. “My hope is the collaborative agreement will be strengthened,” Dr. Shawn Jones of Paducah, past president of the Kentucky Medical Association, told Ungar. “Certainly, physician manpower is an issue in Kentucky and in the U.S. ... but there’s not a great amount of evidence that collaborative agreements impair nurse practitioners from performing their duties.” But Ungar's story notes that NPs sometimes have trouble finding a collaborating physician.

Legislation to let NPs prescribe non-scheduled drugs without a doctor agreement passed the state House but failed in the Senate this year. The NPs aren't giving up, and many are working with state Sen. Paul Hornback, R-Shelbyville, on a similar bill for the next legislative session. Most agree that collaborative agreements are appropriate in the case of controlled substances, such as narcotic painkillers, but other wish to prescribe other drugs too, reports Ungar.

Seventeen states and the District of Columbia allow full prescribing authority for nonscheduled medications to nurse practitioners (see chart below), which means they do not require a signed agreement with a physician. Note that no Southern states allow nurse practitioners to work independently.

A recent report by Deloitte Consulting estimated that the state needs 3,790 more doctors just to meet current demand, which means this is what is needed even before considering the health law or Medicaid expansion. The report says that unlike the need for nurse practitioners, which is balanced between rural and urban populations, the state's doctor shortage occurs mostly in rural areas; the need was 61 percent rural in 2012 and is forecast to be 63 percent rural as Medicaid also expands.

The state needed 183 primary care physicians in 2012, and will need about 284 by 2017. The neediest counties are Bullitt and Spencer, which are close to Louisville. The need is heavily concentrated in the eight southwest border counties, and with Medicaid expansion, it will increase by 42 percent, says the report.

It's clear that large gaps appear in Kenucky's health-care workforce in Kentucky, particularly in rural areas, the Deloitte report says. A more detailed look at the county level is needed to determine the true workforce capacity issues, and can be done by provider type through an interactive tool the firm developed by clicking here.

The need for nurse practitioners in 2012 is relatively low compared to other groups -- 148, or 5 percent of the current supply, says the report. However, "If 6 percent of the current [NP] population were added to the current PCP [primary care provider] supply, the entire PCP gap could be addressed," the Deloitte report says. (NPs are generally referred to as advance practice registered nurses, or APRNs, as indicated on this map.)

To help address this overall provider shortage, Deloitte made 11 recommendations to the state, one of which included authority for nurse practitioners to prescribe less risky drugs without an agreement with a physician. This has been the issue debated by NPs and doctors at the legislature. The report says loosening collaborative agreements could do a lot to address the need for primary care. Giving nurse practitioners more authority has many benefits, including the fact that nurse practitioners who would be able to work more independently may be more likely to set up practice in rural areas.

Some other recommendations in the report include creating support programs for small practices in rural and under-served areas; considering limits on medical malpractice awards; expanding regional rural health tracks to get more new doctors to rural areas and keep them there; and increasing health-care degree and residency capacity across the state.

AMA president, a Kentuckian, says doctors have a duty to make sure patients know about new health-insurance exchanges

Despite the mixed messages from many physicians about the Patient Protection and Affordable Care Act, Dr. Arvis Hoven, an internal-medicine and infectious-disease specialist in Lexington and the new president of the American Medical Association, said the physicians' lobby will do whatever is within its power to promote "Obamacare."

"Our job as physicians will continue to be to get our patients the type of care they need at the right time, at the right place, with the right provider," Hoven told Sarah Kliff of The Washington Post in an interview conducted for C-SPAN’s "Newsmakers." Transparency and communication with patients are important in making sure patients know about health- insurance exchanges, and the AMA can help the American public get the type of care they need and deserve, she said.

Although the law is polarizing and some AMA members don't support it, Hoven said the physician's responsibility is to the patient. "Some supported, some did not support it, but at the end of the day the American Medical Association and its policy body, the House of Delegates, came together in support of the Affordable Care Act."

It is a physician's duty to communicate elements of the law, such as the exchanges, to the patient and his or her family, Hoven told Kliff. As millions of people get added to the health insurance system, "Our job will be to teach them how to use health care insurance, how to get prevention and wellness care on the front end, how to be healthy and stay healthy."

Amid concerns over doctor shortages and the expansion of Medicaid, Hoven said she thinks there will be enough doctors, but it is important for them to emphasize team-based, physician-led care, utilizing all providers at their highest level of training. This will certainly be crucial for the Kentucky health system, since the state needed many more doctors and other medical professionals even before the Medicaid expansion, said a recent review by Deloitte Consulting.

Physicians and communities must work together to make sure there are enough health professionals, Hoven said: "This is work not only physicians need to be involved in, but communities need to be involved in, and we’re going to have to work together both publicly and privately to get this to happen." Click here to watch the entire interview.

Family physicians group objects to cuts to primary-care physician training programs; cites doctor shortage, which is worse in Ky.

Facing an already-existing shortage of primary care in the country and state, the American Academy of Family Physicians sent a letter to U.S. Rep. Harold Rogers, R-Ky., chairman of the House Appropriations Committee, saying the committee's 2014 funding allocations could damage the nation's primary-care infrastructure by cutting primary-care physician training and research programs.

In the June 18 letter, AAFP Board Chair Glen Stream wrote, "We are concerned that the House-proposed allocation will be inadequate to make the necessary investment in vital primary care research and physician workforce training." The proposed allocation would reduce funding for the only federal program that provides funds specifically to academic departments and programs that increase the number of primary-care health professionals, says an AAFP release.

There are not enough primary-care physicians being trained to meet the demand for services, and a recent study shows only a fourth of newly educated doctors actually go into this field. Even worse for Kentucky, which faces a critical doctor shortage amid Medicaid expansion, less than 5 percent go on to practice in rural areas, says a study by researchers at the George Washington University School of Public Health and Health Services. The study's lead author wrote, "If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse."

How can Kentucky meet the critical demand for new doctors when Congress has proposed to make additional cuts to training programs?  Kentucky needed to increase its number of doctors and other medical professionals even before the state decided expand Medicaid, says a recent review by Deloitte Consulting.  The review found that the state needs 3,790 additional physicians, including primary-care doctors and specialists, and the doctor shortage is worse among rural communities.

Lexington internist, Dr. Ardis Hoven, becomes president of the AMA, the nation's largest physician organization

Ardis Dee Hoven, M.D., an internal medicine and infectious disease specialist in Lexington, was installed as president of the American Medical Association at its annual meeting Tuesday night in Chicago. The AMA is the nation's largest physician organization.

Dr. Hoven is a graduate of the University of Kentucky medical school, and she has served in numerous leadership position for the AMA, including her first presidential term in 1993-94. Hoven has also served at the UK’s Bluegrass Care Clinic, which treats infectious diseases including HIV/AIDS, reports Business Lexington.

The AMA is headquartered in Chicago, and since 1847 it has aimed "to promote the art and science of medicine and the betterment of public health," says its website. Furthermore, the organization's strategic focus is aligned with many of the health care issues now facing Kentucky, which are improving health outcomes, accelerating change in medical education and enhancing the sustainability of medical practice.

Doctor shortage news: Residencies are filling the pond with primary care doctors, but U.S. and Ky. need an ocean of them

Despite a critical shortage of primary care in the country, only 25 percent of newly educated doctors go into this field, and even worse for the mostly-rural Kentucky, less than 5 percent go on to practice in rural areas, says a study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

The report, which was just released in the “Published Ahead-of-Print” section in Academic Medicine,  suggests that not only are we facing a primary care shortage, but also that the problem is not likely to be solved soon. There's been a lot of talk about the need to get primary care doctors to practice in Kentucky, specifically in the state's rural areas, without mention of the underlying issue that the study makes clear: there are not even close to enough doctors being trained as primary care physicians in the first place.

In addition to finding that just 4.8 percent of the graduate medical education system practiced in rural areas, 198 institutions (26 percent) produced no rural physicians and 283 institutions (37 percent) produced no Federally Qualified Health Center or Rural Health Clinic physicians, which were created to enhance the provision of primary care services in underserved communities.

“If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse,” said lead study author Dr. Candice Chen, a professor at SPHHS. “The study’s findings raise questions about whether federally funded graduate medical education institutions are meeting the nation’s need for more primary care physicians.”

Currently, the U.S. is producing primary care physicians at rates that are “abysmally low” and unless changes are made to the system, the nation will have an even greater shortfall of primary care doctors just as the Affordable Care Act ramps up demand for these services, said Chen in a Newswise release. And in Kentucky, the additional need for primary care doctors as a result Medicaid expansion is piled onto the heap of issues.

The study's authors said policymakers should take a hard look at the skewed incentives and other factors that have led to the current primary care crisis and develop a more accountable graduate medical education system. It is critical to find a better balance in medical specialties and more primary care physicians to build an effective, affordable health system.

Physician assistants and some doctors urge lawmakers to pass bill that could ease provider shortage in rural Kentucky

Doctors and more than 150 physician-assistant students urged lawmakers Tuesday to pass a bill they stated involves dropping only one requirement in the law and could ease a physician shortage in Kentucky, reports Ryan Nick of cn|2's "Pure Politics."

Passage of Senate Bill 43 would repeal a law that allows physician assistants to treat patients only when a supervising physician is on site for the first 18 months after their certification. If passed, PAs would still be supervised but would be permitted to perform services in a location separate from the supervising physician, as long as that physician can be reached by phone at all times.

No other state requires PAs to have 18 months of on-site supervision. Colorado, the state with the next-longest mandate, requires supervision only for the first 1,000 hours after certification.

The bill's supporters say the burdensome supervision requirement has led to 55 out of Kentucky's 120 counties being medically underserved and has encouraged many PAs to practice in other states, reports Storm. They also say this rule needlessly complicates patient care, especially in rural areas where doctors are stretched thin, reports Melinda Beck of The Wall Street Journal.

The bill's sponsor, Sen. Tom Buford, R-Nicholasville, told Kentucky Health News that he expects the Kentucky Medical Association to seek some changes in the bill, but also expects it to pass because Senate Republican leaders, hospitals and universities support it. "We're educating these PAs at a lot of state expense just to work in other states," he said. House Speaker Greg Stumbo, D-Prestonsburg, told Storm he sees no reason why the bill shouldn't pass. Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, told KHN that she supports the bill.

PAs are expected to be in even greater demand when the health-care reform law brings hundreds of thousands of Kentuckians into the health-insurance system. Beck notes the state is expected to face a greater shortage of physicians, particularly in primary care and rural areas. Buford said, "We're going to provide all this health care for everybody, and there's nobody to go see." For more from cn|2, including video interviews, click here.