15% fewer med-school grads applied for residencies in Kentucky this year; med-school association attributes that to abortion ban

Photo by Phallin Ooi, Creative Commons

By Sylvia Goodman
Kentucky Public Radio

The Association of American Medical Schools says 15 percent fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, part of a trend related to states' strong anti-abortion laws enacted after the federal right to abortion was abolished. The decline was even greater in programs for obstetricians and gynecologists.
 
The study found that U.S. medical students were less likely to put in an application in states with abortion bans in place. The state's near-total abortion ban only allows exceptions if the mother is in imminent risk of death or permanent injury to a life-sustaining organ.

Dr. Atul Grover, executive director of the AAMS Research and Action Institute, found that 15% fewer U.S. medical students applied to residency programs in Kentucky during the last academic year compared to the 2022-23 school year. That’s 1,050 fewer applicants across specialties.

In OB-GYN programs, there was an even sharper 23% decline, Grover said. “We do see these trends across specialties, though,” he said. “People get a little jittery around the idea that the state government is going to come in and tell you what is not appropriate care for a patient when you know otherwise.”

Grover noted that medical students overall applied to fewer schools, meaning students got pickier in where they applied. That accounts for some of the decrease in applications across states, but the remaining deficit, he said, is cause for concern — particularly to states with abortion bans.

“Health-care shortages, across specialties, across a lot of states, are already being felt by patients,” Grover said. “If I think about Kentucky, Alabama, Mississippi, these are states that already have trouble attracting and recruiting, retaining physicians.”

Kentucky hospitals are already dealing with an “acute shortage” of health care workers, with nearly 13,000 job vacancies in hospitals at the end of 2022, says the Kentucky Hospital Association.

Grover said medical-residency application numbers are one of the fastest ways to measure where doctors are moving or interested in moving. Other metrics are harder and take longer to track. Residents have a tendency to stay in the state where they train.

Grover said lawmakers should understand the full implications of abortion bans, especially in a state that already suffers from several physician shortages, including in women and reproductive health fields. According to the U.S. Health Resources and Services Administration, more than half of Kentucky’s 120 counties didn’t have a single OB-GYN specialist in 2022-23.

Louisville pediatrician Dr. Michelle Elisburg said many doctors entering residency are in their mid-to-late 20s, and may be considering having children themselves. The bans may keep those women or their partners from considering moving to the state either.

“You wouldn't come if you're a young woman and know that if something happens to you, you might die because they aren't gonna let you get the health care you need,” Elisburg said. “That's where you are going to lose the doctors.”

Elisburg was part of the lobbying effort by Kentucky Physicians for Reproductive Freedom to end the state’s abortion bans this year.

She said the bans keep students from receiving all the training they need to provide abortion care or require them travel out of state to get it. “If there's such a ban, that restricts the kind of training that people are able to do,” she said. “They're not going to want to come to a state where they can't be completely trained in all the techniques in their field.”

Blair Wooten, who attended the University of Louisville medical school, said the state’s abortion ban was one of the reasons she decided to leave the state. She ended up going to a program in Ohio for the last year. She said abortion medical training “is paramount to me. It's something I want to be in my practice.”

Wooten is moving to a residency program in Indiana, which has its own abortion ban, but that program gives students the opportunity to receive abortion training in a Detroit-based program, which eased some of her fears — and clinics in Ohio are just a few hours drive away.

Wooten said she’s not sure if she’d consider setting up a practice in a state without abortion access. She said the inability to immediately provide the care she believes is necessary would be painful, but she also wants to provide services in health care deserts.

“Family planning is something I want to be a big part of my practice, so I usually say, ‘No’,” Wooten said. “But I'm also keenly aware that people need resources in every place, especially places that are maybe a little more hostile. And they need providers who care and can help them even with limited resources.”

UK students planning medical careers start student organization to steer rural students into college and health-care opportunities

Jackson Miller, left, and Ethan Morgan started HealthCare Cats to help other students from rural areas navigate the many health-care education opportunities at the University of Kentucky. (UK photo)

By Adrienne Clarke
University of Kentucky

Jackson Miller and Ethan Morgan, former Marshall County High School classmates and now best friends and roommates at the University of Kentucky Lewis Honors College, first arrived in Lexington feeling a bit overwhelmed of all the opportunities available to them UK.

Coming from a rural area where most high-school graduates enter the workforce or the military rather than college, Miller and Morgan felt they did not have a clear roadmap of how to pursue their career aspirations of becoming physicians. To help other students not feel so lost in navigating all of the health care education opportunities, Miller and Morgan created a student organization during their sophomore year to help other students like them. The organization, HealthCare Cats, is now “providing an avenue into college and health care opportunities for rural students of Kentucky in order to create a better commonwealth.”

To start their program, Miller, a psychology major, and Morgan, a biology major, worked with several UK colleges focused on the health-care industry including the College of Medicine, College of Dentistry, College of Pharmacy and College of Nursing, for information about how to present themselves as the best candidate for those types of degrees. The students then developed a presentation that has been shared with rural high-school and college students to encourage them to aspire to a career in health care and show them the different options and opportunities that are offered at UK.

“We wanted to help students who felt behind, didn’t have the greatest study habits and most certainly weren’t aware of many of the opportunities in health care,” Miller said. 

The organization, which already boasts over 160 students, will include guest speakers, networking opportunities and a mentoring program to connect first-year students with more experienced students.

“These opportunities for the members of the organization will allow us to not only reach the younger, rural generation, but also cultivate a community of future rural health leaders within the organization,” Morgan said.

Already, the organization has had speakers such as Dean Christian Brady from the Lewis Honors College, who spoke to the organization on discovering your “why” for health care and education, combating burnout, handling changes in the path of life, managing adversity in life, and more. The organization also held a graduate student panel with students from nursing, medicine, physical therapy, the physician assistant program, dentistry and pharmacy. The students shared application tips, pros and cons of their programs, and advice they would consider if they had to do it all over again.

This Friday, Dec. 1, HealthCare Cats, in partnership with the Appalachian Health Initiative, will welcome Dr. Michael D. Rankin to speak at 5 p.m. in the Lewis Honors College Scholars Lounge. Rankin, a graduate of UK, recently pledged $22 million to “advance the mission of the UK College of Medicine and expand the top-notch educational opportunities through the support of a new health education building and the funding of medical student scholarships,” as stated in the UKMedicine magazine.

Rankin had quite a non-traditional path to medicine, as he graduated from his undergraduate studies and spent six years in the electrical engineering field to accumulate enough funds to attend medical school. This was a common occurrence in Rankin’s life, as he explains how before attending UK for his undergraduate career, his family resorted to selling a cow to afford the tuition. Rankin has provided unconditional support for those with similar backgrounds to himself attempting to enter the medical field, as he understands the struggles of attending college from a rural environment.

“Dr. Rankin coming to speak with us will be great, for he will understand the backgrounds of our membership and be able to offer advice from the perspective of someone who has walked their paths,” Morgan said.

“Having worked with students Maddie Duff (president) and Ben Vickery in the past, it is clear that the missions of our organizations align in critical ways. Dr. Rankin speaks very highly of Appalachian students and often notes the need for them in Kentucky’s health care system. We are so excited to be able to bring in their diverse perspectives and work together to build a better commonwealth.”

Supplementing the event programming, HealthCare Cats initiated a mentorship program where rural first-year students are matched with an upper-class student to make the college/pre-health transition smoother. The first director of HealthCare Cats’ the program, Maya Moskal, is from Chicago and is considering a career in a rural market.

"Being from a bigger city, HealthCare Cats has broadened my knowledge on the health care disparities present in rural areas,” she said. “The program has opened many doors by encouraging me to give back to Kentucky, in addition to helping me personally succeed at UK in many ways.”

Through HealthCare Cats, Miller and Morgan hope to apply the common chemistry phrase “like dissolves like” by helping rural students achieve their medical aspirations — and then return to their hometowns.

Morgan asked, “Who better to serve rural populations in Kentucky than those who resided there for much of their lives?”

UK's latest federal grant to increase number of primary-care doctors in rural Kentucky includes new scholarship opportunities

Medical students Katelin Maggard and Anna Cox on the College of Medicine-Bowling Green Campus, a partnership of UK, Western Kentucky University and Med Center Health. (Photo by Clinton Lewis)

By Allison Perry

University of Kentucky

The University of Kentucky College of Medicine has received a four-year, nearly $16 million grant from the federal Health Resources and Services Administration. UK will get $3.97 million a year over the next four years to support efforts to increase the number and diversity of primary-care physicians in Kentucky, with the ultimate goal of improving health-care access in underserved areas of the state.

The physician shortage is not unique to Kentucky, nor is it limited to primary care. A2021 report from the Association of American Medical Colleges estimated that national demand for all physicians will exceed the existing supply by 37,800 to as many as 124,000 by the year 2034.

In Kentucky, 61% of the greatest physician needs are in rural areas. In rural and under-served areas, primary-care physicians are often the residents’ only exposure to any health-care professional, highlighting the need to improve access to these physicians.

UK's Rural Physician Leadership Program trains students

at Morehead who are interested in practicing rural medicine.

(UK photo by Jorge Castorena)

The UK College of Medicine has worked with academic and clinical partners to meet this growing need through four regional campuses in Lexington, Morehead, Bowling Green and Northern Kentucky, and graduated the largest-ever class this past spring.

These partnerships were a key to getting the new grant, which will focus on expanding pathways to support students who are interested in medical school and providing scholarship opportunities for medical students who choose primary care as a career path.

The goal is not just to increase the number of primary care physicians in the state, but to encourage new physicians to practice in underserved communities upon graduation, said Charles “Chipper” Griffith III, M.D., dean of the College of Medicine.

“As a physician who has provided primary-care services for patients of all ages, I can tell you firsthand how important it is for people to have access to these providers,” Griffith said. “An established relationship with a primary care physician is a first line of defense against acute and chronic illness and injuries. We not only provide treatment for illness, but we actively work to help our patients prevent it by identifying risk factors and screening for disease. In a state that suffers from high rates for many chronic, preventable diseases, increasing access to primary care is a critical step in improving the health of our citizens.”

Path to primary care can start in middle school 

UK already had several programs to provide educational experiences as students navigate the pre-med journey. With help from the new grant, these programs will place a greater focus on primary care, which includes family medicine, general internal medicine, general pediatrics, or the combination of internal medicine/pediatrics commonly known as Med/Peds.

The pathway to a medical career begins years before students reach college. Educational opportunities need to begin early — ideally, by the eighth grade, says James Ballard, director of UK's Center for Interprofessional and Community Health Education.

Promising students are identified with teh help of UK’s Area Health Education Center program, a collaborative effort between UK, the University of Louisville Health Science Centers, and eight regional centers. They provide support to help students meet their goals, including assistance in planning which classes to take in high school, help with applying for college, and encouragement from health-care role models.

At the high-school level, AHEC offers two free residential summer camps at UK that will be revised and funded through the new grant. The Summer Enrichment Program, for rising high school juniors, is a residential camp that allows students to gain some early college experience by spending three weeks learning, observing, and working hands-on with UK faculty, health professionals and health professions students. The program will add more mentoring specifically from primary-care physicians to provide more specific education on what a primary-care physician can do for patients, and understand how primary-care physicians function in a collaborative system.

The Health Researchers Youth Academy takes a similar approach, but is more tailored to the research side of a medical career. The residential programs connect high-school students with researchers, teach them research methods, and give them experience working in a laboratory. At the end of the camp, students will present their findings through poster presentations. In terms of primary care, the camp will educate students more on a primary care physician’s role in translational research — in other words, how basic science at the bench ultimately becomes a part of everyday patient care.

Though the Center for Intreprofessional and Community Health Education aims to create more health professionals across all spectrums, it will extol the benefits of choosing primary care, Ballard said.

“We’ve always exposed students to a variety of professions in the past, but we want to get more specific when it comes to primary care. We want them to understand ‘This is what a primary care physician does, this is why it’s important, this is why it’s valuable to you’,” Ballard said. “It’s amazing what primary care physicians can do, especially in rural and underserved areas. We want to show them what a difference they can make in their community by choosing this as a career.”

New initiatives funded by this grant will include two post-baccalaureate programs for students who have graduated from college, to provide opportunities for students to complete prerequisites for medical school and/or receive additional support and training to improve their chances of being accepted into medical school; a pre-matriculation program to prepare incoming medical students for the rigors of the curriculum and to highlight the benefits of choosing primary care as a career path; and a primary-care scholarly concentration, which will include targeted coursework and an enhanced community clinical rotation at a rural teaching health center.

Reducing debt for future primary care physicians

Research shows that students with large college debt are less likely to choose primary-care specialties because they have lower compensation in comparison to specialty and sub-specialty practices. Also, these graduates are less likely to practice in underserved communities.

The new grant will also allow the College of Medicine to provide up to $2.88 million a year in scholarships to students with demonstrated interest in primary care.

The new scholarships are positioned to decrease the debt burden by half for 80 students, and by a quarter for an additional 32 students. By reducing this burden, the team anticipates that more students will be likely to follow their passion for rural medicine and making a difference in underserved communities.

“Investing in the education of medical students through scholarships is not just an act of philanthropy, it’s an investment in the future of health care in Kentucky,” said Dr. Stephanie White, senior associate dean in the College of Medicine. “This award will be life-changing for our students who wish to pursue a career in primary care and have the desire to make a difference in underserved communities. These scholarships won’t just alleviate financial burden — they will empower dreams and nurture the talents of our next generation of primary-care physicians.”

U of L gets grant to expand doctor training for under-served areas

The U of L medical school is the state's oldest. (WDRB image)

The University of Louisville has received a $16 million federal grant help train more primary-care physicians in rural and urban areas that need more doctors who focus on family medicine, general internal medicine, pediatrics and internal medicine.

The goal of the four-year grant is to encourage young doctors with those specialties to consider practicing in under-served communities, which most Kentucky communities are.

"We know that students who train in these rural locations are more likely to practice there, and our hope is that by strengthening these programs, we'll be able to immerse students in these communities and increase the number of primary care physicians in underserved regions across the commonwealth," Kelli Bullard Dunn, vice dean of community engagement and diversity for the U of L School of Medicine, said at Monday's announcement.

"We have such a need in Kentucky and all over," said Faye Jones, associate vice president for health affairs and diversity initiatives at the UofL Health Sciences Center.

Most of the state's 120 counties, and at least some portion of 113 of them, including parts of Jefferson County, are designated by the federal government as as Health Professional Shortage Areas. "Recent projections rank Kentucky lowest among the states in meeting the need for primary care physicians by 2025," Darby Beane reports for WDRB.

The grant will expand U of L's path for students to help under-served areas. The medical school will create a new program to train medical students in west Louisville and other urban communities.

The progran will be modeled on the school's Trover Rural Track, which offers primary-care clinical training in conjunction with its family-medicine residency programs in Glasgow and Owensboro. Students in the program complete their final two years of medical school at the Trover Campus in Madisonville, part of Baptist Health Deaconess Madisonville.

"According to the school, of the 170 physicians who have graduated from the Trover Rural Track so far, 75% practice primary care and 43% practice in rural communities," WDRB reports.

"The project also plans to enhance a university program that prepares individuals with a bachelor's degree in a different field to enter medical school. In addition, the grant will also help provide scholarships to support students in these programs."

The grant comes from the Health Resources and Services Administration.

Annual health-policy forum Oct. 11 in Lexington will focus on health-care workforce shortage; discount hotel rate expires Mon.

A strong and robust health-care workforce is fundamental to ensuring access to high-quality care, but  many areas of Kentucky have a shortage of this vital resource. Kentucky's health-care workforce shortage will be the focus of the Foundation for a Healthy Kentucky's 2023 Howard L. Bost Memorial Health Policy Forum, to be held at the Griffin Gate Marriott in Lexington from 9 a.m. to 4 p.m. Oct. 11. Doors will open at 8:15. 

The forum will highlight factors contributing to the health-workforce shortage and explore potential solutions. Presenters and panelists will discuss ways to better support health-care providers, optimize use of resources and explore ways to sustain the current workers.

The forum is free of charge. Register here. Hotel rooms are available at a discounted rate through Monday, Sept. 18, for the night before and after for those who are interested. Book here.

The forum will open with the presentation of the Gil Friedell Award, the annual winner of which is selected from among the foundation's Healthy Kentucky Champion honorees.

The morning sessions will include a presentation from Kevin McAvey, director of Manatt Health Strategies, on "How States Are Investing in their Systems of Health to Meet the Needs of a Data-Driven Future."

This will be followed by TED-talk-style presentation by Dr. Stephen Houghland, chief medical officer of the Kentucky Primary Care Association and Tiffany Taul Scruggs, patient-service outreach manager for Sterling Health and a certified community health worker.

Sen. Stephen Meredith

The keynote address, "How Do You Fix an Irretrievably Broken Health-Care System," will be given by state Sen. Stephen Meredith, a Republican from Leitchfield.

Meredith spent decades as a leader in health-care administration before being elected to the Senate in 2016. When he retired from Twin Lakes Regional Medical Center, the hospital was one of the four financially strongest hospitals with under 100 beds in Kentucky. He was also CEO of the Grayson County Hospital Foundation, which employed most of the local medical practitioners and managed their practices.

Meredith is chair of the Senate’s Health Services Committee, co-chair of the Government Contract Review Committee, and a member of other committees, including the recently formed Family and Children Committee.

David Gross

Afternoon segments will offer choices of panel sessions. 

"Finding Funding and Preparing the Pipeline" will address how rural health providers can pursue state funding to address the workforce shortage. It will also address how the next generation of providers is being strengthened. The panelists for this session are from area health education centers: David Gross, director of the northeast center; Michael Gayheart, the southeast director; Catherine Malin, south-central director; and Missy Stokes of Purchase AHEC.  

The segment's other session is "Streamlining the Process," about licensing, accreditation and certification. This panel will focus on the importance of data sharing and making credentialing more manageable.

Emily Beauregard

Panelists include Emily Beauregard, executive director of Kentucky Voices for Health; Rosmond Dolen, associate vice president for payer relations and health policy finance at the Kentucky Hospital Association; and Jeffrey Talbert, professor at the University of Kentucky and division chief of biomedical informatics in its College of Medicine. The moderator will be Angela Carman, associate professor in the Health, Behavior & Society Department of the UK College of Public Health.

The afternoon's second segment also offers two options. 

"Closing the Gaps: Meeting the Needs of the Underserved," will discuss policies and programs to get providers to work where they are needed most. 

Matt Coleman

Panelists will be Matt Coleman, director of the Kentucky Office of Rural Health; Frances Feltner, director of the UK Center of Excellence in Rural Health; state Rep. Ken Fleming, R-Louisville; Dr. Donald Neel of Louisville, a leading pediatrician; and Pam Sparks Stein, dean of the dental college being created at the University of Pikeville. The moderator for this session will be Dr. Laura Hancock Jones, a Morganfield dentist.

"Helping Providers Survive and Thrive" will focus on how workplace and community support can help beat the burnout for the healthcare workforce.

Panelists will be Charles Aull, executive director of the Kentucky Chamber of Commerce Center for Policy & Research; Delanor Manson, CEO of the Kentucky Nurses Association; and Eric Russ,  executive director of the Kentucky Psychological Association. The moderator will be Tim Marcum, associate vice president of planning at Baptist Health.

Kentucky keeps losing doctors when it needs more of them; in the 2022 fiscal year it had only seven for every eight it had in 2018

Ky. Health News graph from UK Center for Excellence in

Rural Health data; there are no data for Fiscal 2021 due to

the pandemic. (Click on any image to see a larger version.)

Kentucky Health News

Kentucky is losing physicians at a time when it needs many more of them, the top executive of the Kentucky Medical Association told a legislative committee Wednesday.

From 2019 to 2022, the last fiscal year for which data are available, “We lost 590 physicians out of the state . . . at a time that we needed more physicians in the state,” KMA Executive Vice President Patrick Padgett told the Interim Joint Committee on Health Services.

And the loss is even bigger going back to Fiscal 2018, the year that the number of licensed physicians in Kentucky peaked at 11,437. (Fiscal years run from July 1 to June 30.) In Fiscal 2019, the number dropped to 10,592. That was a drop of 7.4 percent. The decrease from 2018 to 2022 was just over 12.5 percent. That's one-eighth, so for every eight doctors in 2018, the state had only seven in 2022.

The decline in primary-care physicians was much less, 3.4 percent: from 2,825 to 2,729. However, 43 of the state's 120 counties are considered short of primary-care doctors, and Kentucky ranks 40th in the nation in the number of primary-care physicians per 100,000 people, according to a report by the University of Kentucky's Center for Excellence in Rural Health. It says 25 counties are considered short of doctors overall, and "Almost a third of Kentucky physicians have been licensed between 31 and 50-plus years," meaning many will retire relatively soon.

Padgett told John McGary of WEKU-FM that having fewer doctors overall "means that people have to wait longer to see a physician. I think that anyone around the state who tries to get in to see a physician, whatever the physician specialty, wherever they're located, when you have to wait weeks, or sometimes months to get in to see a physician, you're experiencing this problem." 

KMA executive Patrick Padgett

Padgett told the committee, “Three years ago, I would have come here to say that Kentucky badly needed more physicians. And unfortunately, the situation has only gotten worse. And we really need to work to not only bring in more physicians but keep the ones that we already have.”

A KMA survey last fall "showed many of the state’s physicians are dealing with increased levels of stress," notes Sarah Ladd of the Kentucky Lantern. "The degree to which that affected their work varied. Most cited administrative burdens such as prior authorization requirements as a driving force behind their stress. During the 2023 legislative session, legislators considered adding exemptions to the state’s prior authorization requirements, but the bipartisan bill was stuck in a committee."

The General Assembly did pass a bill to protect Kentucky doctors who seek mental-health help from wellness programs, by saying doctors don't need to report their participation, Ladd notes: "Their jobs will also be safe if they do so."

Much of the decline in licensed physicians came during the Covid-19 pandemic, when much attention was given to the increasing shortage of nurses. Delanor Manson, CEO of the Kentucky Nurses Association, told the committee that the state needs to improve the health-care workforce pipeline and keep nurses in the profession, Ladd reports.

“Health care is the engine for the economy,” Manson said. “And nurses are the engine for health care.”

UK hospital, celebrating 60th anniversary of its opening, recalls the governor for whom it was named: A.B. 'Happy' Chandler

A.B. Chandler breaks ground for the hospital. (UK photo)

As the University of Kentucky celebrates the 60th anniversary of the opening of its medical center, it asked the grandson of the governor who campaigned for it, and for whom it is named, to reflect on what it means to the state.

Ben Chandler, who had his own political career and now runs the Foundation for a Healthy Kentucky, said in a video interview with UK that A.B. "Happy" Chandler "felt like an institution was needed, which not only educated health care providers who would then fan out across the eastern part of the state, but also a place where people from Eastern Kentucky could come to get health care. . . . Eastern Kentucky had a high rate of infant mortality, they had several counties that had no physician at all, and almost no health care whatsoever."

The Albert B. Chandler Hospital has done "incalculable" good, Chandler said. "There's just no way you can describe it. Not only do you have the medical benefits that accrue as a result of the establishment of this institution, but the economic advantages that are connected with it. UK HealthCare is one of the largest employers in Lexington and Central Kentucky. And if you can think about the importance of this from an economic standpoint for the city of Lexington, it really just boggles the mind. There are very few things that have happened economically in Lexington that have been as important as the establishment of this medical facility."

Albert Benjamin Chandler III said his grandfather "would be really astonished at the growth and at the stewardship that has taken place throughout these years. He would be very, very proud of the people who were instrumental in building this institution. And he would just be incredibly proud of their stewardship of it over the years, and probably pretty surprised at just how dramatic its effect has been."

Many rural areas still short of doctors; UK's health VP says recent federal funding hike for med-school resident slots was inadequate

Photo from The Lane Report

Just like the rest of the nation, Kentucky needs more doctors, and people and institutions in the state are working on several initiatives to address the challenge. 

The U.S. faces a projected shortage of between 37,800 and 124,000 physicians by 2034, including upwards of 48,000 primary-care physicians and upwards of 77,100 specialists, according to The Complexities of Physician Supply and Demand: Projections From 2019 to 2034, a report released by the Association of American Medical Colleges.

The report cites several reasons: demand for services increases as the population ages and grows larger; many physicians are nearing retirement age; and the demands of the pandemic will accelerate retirements.

The pandemic has also raised awareness of the disparities in health care, emphasizing the need for more access to care, meaning we need more doctors.

For The Lane Report, a Lexington-based business magazine, Jeff McDanald reported how Kentucky's medical schools are stepping up to meet the challenge. 

Kentucky ranks 40th among the states in primary-care physicians per 100,000 people, with only 2,696 practicing statewide, McDanald reports.

“There is certainly a maldistribution of primary care providers, with four of our counties (Ballard, Metcalfe, Owsley and Robertson) having no primary care physician and eight others (Bath, Carlisle, Edmonson, Hancock, Hickman, Nicholas, Spencer and Webster) having only one,” Dr. John Lee Roberts, vice dean for graduate and continuing medical education at the University of Louisville School of Medicine, told McDanald. “And 75 of our 120 counties are classified as primary-care health-profession shortage areas.”

One way U of L has worked to improve these numbers is offering scholarships to help offset medical-school debt.

“The average student-loan indebtedness of a graduating medical student is now well over $200,000,” Roberts told McDanald. “A partnership with the Greater Louisville Medical Society has been generating five or six scholarships per year for University of Louisville students.”

U of L and the University of Kentucky have also secured more Medicaid support for graduate medical education in the state, which has led to more resident and fellow positions in the past few years, which is key to alleviating the doctor shortages, McDanald reports.

However, Dr. Mark Newman, executive vice president of health affairs at UK, told Kentucky Health News that while the Centers for Medicare and Medicaid Services has increased funding for residency slots, it is not enough. 

"UK welcomes this important funding; however, we estimate that it will likely result in just five additional slots for UK over five years," Newman said in an e-mail. "We will continue to work with our national associations on the need for additional funding for graduate medical education." 

McDanald reports that the state’s three medical schools combined graduate about 500 students each year, but there are only about 400 entry-level residency positions in the state.

“Kentucky is a net exporter of doctors,” Roberts said. “We need more entry-level residency positions in Kentucky, and that starts with funding. . . . This is important because we have good data that shows 45 percent of the students who go to medical school in-state will ultimately practice in the state. Similarly, 45% of the residents and fellows who do their residency and fellowship in the state will ultimately practice in the state. But if you have Kentucky medical students who stay in Kentucky for residency and fellowship training, the numbers increase significantly to 74% of them who will end up practicing in the state.”

Role of economic development

Dr. Brent Wright of Glasgow, who has spent his career at a rural family medicine training program, told McDanald that while it is medical schools' responsibility to train residents, it is the responsibility of hospitals and communities to recruit them. Wright is associate dean for rural health and as an associate professor of family and geriatric medicine at U of L.

“Some communities do an extremely good job of referring physicians and are well aligned to their local government, but I think some places struggle,” Wright told McDanald. “When you recruit a physician you recruit the spouse, who may also want to work in the community. And if they have children, they’re looking for a good school system.”

“The ultimate placement of a physician in a community is really a team sport,” Wright said. “Communities need good infrastructure. This gets back to economic development, and if you have areas that start to become depressed, it’s really hard to reverse that.”

Geographic challenges

Dr. Charles H. Griffith, acting dean of the UK medical school, talked to McDanald about the need for physicians in rural parts of the state, especially when it comes to mental-health care. 

"Kentucky is one of the worst states for under-served areas," Griffith told McDanald. "In some areas like Lexington and Louisville we probably do have sufficient doctors, but in our rural areas—which is a lot of the state—there is a dire need. We need primary-care doctors everywhere, but to be honest, there is a need for some of the general specialists out in rural areas.”

Griffith added that there is a great need for more psychiatrists in Kentucky.

“It’s especially evident with the mental-health crisis that’s been exacerbated by the pandemic,” he said. “There are just not enough psychiatrists to meet the mental health needs of children and adults, too.”

Griffith also noted that other health care providers, like nurse practitioners and physician assistants, are meeting some of the need to provide health care in Kentucky, noting that they "can do quite a bit." 

Home-grown rural doctors

Another approach to get more physicians to practice in rural areas is to recruit rural medical students and provide rural residency programs, which is what the UK's Rural Physician Leadership Program aims to do. 

“The program is based on the idea that it’s sometimes difficult to transplant someone into an underserved or rural area who is not familiar with the community,” Dr. Rebecca M. Todd, who heads the program in Morehead, told McDanald. “So instead, we go with the opposite approach of recruiting young men and women right out of these communities to go to medical school. Therefore, they are in tune with that patient population, they love the community, and they want to live and work there. It’s been a phenomenally successful program." 

So much so that UK has now opened two larger regional campuses in Bowling Green and Northern Kentucky, McDanald reports. 

The University of Pikeville's Kentucky School of Osteopathic Medicine has also helped to supply primary-care physicians to rural areas. 

“Pike County used to be a medically underserved area and is no longer such because of the number of physicians who have come back to the area or have been attracted to the area partly due to the medical school being here,” Dr. Joe Kingery, dean of the osteopathic school, told McDanald. 

Kingery told McDanald that  83% of UPike osteopathic graduates practice in primary care and stay in Kentucky, which exceeds the percentages for UK and U of L medical-school graduates.

“We have 57% of our graduates who are practicing in a rural area in Kentucky,” Kingery said. “It speaks to our story that we’re placing primary care physicians into underserved areas and the Appalachian region.” Kingery said. “That being said, our graduates can go into any specialty they want. We have orthopedic surgeons, neurologists, neurosurgeons, you name it. In a given year, we usually graduate about 125 to 130, with 65% to 70% of our graduates going into a primary care residency program. And for us, primary care is defined by only three specialties: family medicine, internal medicine and pediatrics.

In January, Campbellsville University welcomed the first class of students to its School of Chiropractic, the first in Kentucky and the only one within a 300-mile radius. It's in Harrodsburg.

“We’re responding to the doctor shortage by graduating doctors of chiropractic trained much like any physician as a port-of-entry care provider," Dr. Trevor Foshang, dean of chiropractic education, told McDanald.

Anthem funds scholarships for Eastern Kentucky health workers

By Leon Lamoreaux

President, Anthem Kentucky Medicaid

For generations, Kentucky’s rural communities have been built by families, separated by miles and miles from the nearest city. Those miles of separation are both a blessing and a burden. Families enjoy wide open spaces and a different pace of life, but amenities like hospitals and health specialists can be far from home. Visiting a doctor or hospital can be a challenge because of the distance and expense. Here in Kentucky, that distance and availability of healthcare resources put rural residents at a health disadvantage.

Today, Kentucky hospitals report a 10 to 40 percent vacancy rate of nursing positions, with the highest need found in rural areas. Health-care researchers estimate that Kentucky’s rural communities will need another 40 primary-care professionals to properly serve the population. That shortage translates to some 102,000 Medicaid beneficiaries in Kentucky who lack sufficient access to a primary care provider.

The Kentucky Center for Statistics estimates that Eastern Kentucky alone will require nearly 2,000 more nursing jobs by 2024 — less than three years from now.

Leon Lamoreaux

Kentuckians who live in rural communities deserve reliable access to adequate healthcare, and to meet those needs, we must expand the pipeline of healthcare professionals. That’s why Anthem Blue Cross and Blue Shield is launching the Anthem Rural Medicine Scholarship program with two Eastern Kentucky educational institutions. By funding education for future healthcare workers, we can grow the number of practicing professionals in rural Kentucky, improve health outcomes and strengthen the communities we serve.

The scholarships at Hazard Community and Technical College and Eastern Kentucky University are drawn from new Anthem-funded endowments, which means the funds for supporting new health-care students will last for years, not just for the next few semesters.

Scholarship recipients are required to practice in a federally recognized shortage area for a minimum of three years post-graduation, creating primary care access to at least 7,500 rural Kentuckians each year.

Leslie County native Kimberly Caldwell was among the first scholarship recipients. “This scholarship will allow me to work toward my dreams to become a nurse, without having to worry about the financial burden that can come with getting an education,” said Ms. Caldwell.

I was honored to meet Ms. Caldwell and congratulate her on serving the region she loves.

Rural Kentucky is full of unparalleled natural beauty as well as thousands of hardworking families and individuals who treasure their small towns. By funding education for future rural health providers, Anthem is helping to build brighter futures for all Kentucky families — no matter where they live.

Lamoreaux runs Anthem Blue Cross and Blue Shield's Kentucky Medicaid plan, which serves more than 160,000 beneficiaries.

Bill to let physician assistants prescribe passes first hurdle; Ky. is only state where they can't, causing health-care access issues

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to allow physician assistants to prescribe highly regulated drugs, a step advocates say is needed to improve health-care access in rural Kentucky, is finally moving through the legislature.

L-R: Andrew Rutherford, Rep. Steve Sheldon, Laurie Garner

"Kentucky is the last state in the U.S. where PAs don't have some form of controlled-substance delegation. The other 49 states have it already," said the bill's main sponsor, Rep. Steve Sheldon, R-Bowling Green. "And no state has ever reduced or rescinded the authority that has been given."

House Bill 135 would allow "modified prescriptive authority" of controlled substances in Schedules II, III, IV, and V after the PA has been licensed and has practiced for one year.

It passed the House Health and Family Services Committee Jan. 30 with a committee substitute. This was the fourth time the legislation had been filed, and the first time it had been brought up in committee for a vote.

Leaders of the Kentucky Academy of Physician Assistants urged passage of the bill, explaining that under the current system a supervising physician has to sign off on any controlled substance prescription written by a PA. They said this results in decreased access to care, delays in care, poor prescribing transparency, and ultimately results in Kentucky PAs moving to other states.

"Our graduating PA students are leaving the state of Kentucky to practice in other states where they have less restrictions and more job opportunities," said Laurie Garner, president of KAPA. "By passing this bill we will keep our best and our brightest in our state rather than seeing them leave for better opportunities elsewhere."

She also offered an example of how the system results in delayed care, noting that because she is often the only provider at her clinic, her patients who need a controlled substance prescription or a refill must wait until the supervising physician is able to co-sign for it, and often end up canceling appointments when she can't immediately help them.

Andrew Rutherford, vice-president of KAPA, said the bill would increase transparency, since drugs would be ordered under the PAs' Drug Enforcement Administration numbers instead of their supervising physicians' numbers.

"It will also allow PAs to be accountable for the controlled medications that they prescribe, based on their treatment plans," he said. "Currently a supervising physician signs off on all these prescriptions and this is falsely inflating many physicians' prescribing numbers."

The bill includes several restrictions, including only allowing PAs to prescribe a three-day supply of Schedule II drugs, with no refills. Schedule II and III non-narcotic substances would be limited to a 30-day supply with no refill; and Schedule IV and V drugs would be limited to the original prescription, with refills to not exceed a six-month supply.

It also carves out several Schedule IV drugs that can only be written as a 30-day supply without any refills, including: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) and carisoprodol (Soma).

Administration of the program would fall under the Kentucky Board of Medical Licensure, and a PA's license to prescribe such drugs would need to be renewed every two years. The measure also includes new rules around continuing education requirements, including a number of required hours related to controlled substances.

Under the regulation, PAs would still have to work under the supervision of a medical doctor and that physician would be allowed to limit which controlled substances their PAs can prescribe, or if they want to participate in the program.

NE Area Health Education Center wins national award for getting Appalachian students into med school; program going statewide

The award was one of three in the nation.

The Northeast Kentucky Area Health Education Center at Morehead won the Center of Excellence Award in Distribution at this month's national AHEC conference for working to improve the health-care workforce in rural and under-served areas.

The AHEC was nominated for its Successfully Training and Educating Pre-medical Students program. STEPS was created in 2013 to level the playing field for their local students who are interested in applying to medical school.

Most of the 17-county Northeast Kentucky AHEC service region is in Appalachia, which has long been short of physicians.

"Studies have shown these physician shortages to be partially attributable to factors including Appalachian students’ inadequate academic preparation, limited exposure to health care occupations, low self-confidence, and financial considerations," a news release said.

The STEPS program helps the participants prepare for the Medical College Admission Test with courses, mock interviews, assistance with the application, physician shadowing, and other activities.

“The purpose of STEPS is to produce not just more, but more competitive, medical-school applicants from our region,” said David A. Gross, director of the Northeast Kentucky AHEC. “In part because of this program, we continue to see meaningful increases in the number of local students applying to and being accepted by in-state medical schools.”

The release says three groups of students have completed the program, and 22 of the 25 students who met all program requirements enrolled in medical school.

The Northeast Kentucky AHEC has also recently entered into a two-year contract with the Kentucky Primary Care Office to replicate the STEPS program with the other seven Kentucky AHECs.

“It’s quite an honor to be chosen by our peers for one of only three Center of Excellence awards among the nation’s nearly 250 regional AHECs,” Gross said.

Nonprofit hospital firm in Northern Ky. gives UK $2.5 million for scholarships for students at new med school going up in area

St. Elizabeth Healthcare has given the University of Kentucky $2.5 million for a tuition scholarship program at the medical school UK plans to open in Northern Kentucky two years from now. The nonprofit health-care firm is part of the effort to create the school, which will also be affiliated with Northern Kentucky University.

“In providing these scholarships, we are making an enormous investment in the future of the health of our community,” Garren Colvin, president and CEO of St. Elizabeth, said in a UK news release. “With our partnership with the University of Kentucky, we will be able to provide additional benefits to both organizations as well as the region and commonwealth by directly assisting in medical school support and recruitment for the Northern Kentucky campus.”

The scholarships will be go to medical students who remain enrolled full-time at the Northern Kentucky campus, meet the college’s financial need requirements and remain in good academic standing and progress toward completion of the M.D. degree.

“This scholarship program, seeds sown in ground made fertile by a willingness to care for others, will ripple through many generations of health practitioners,” UK President Eli Capilouto said in the release. “We are grateful to St. Elizabeth’s leadership and the donors who support this remarkable gift, one that will directly support medical students, and ultimately the patients whose names the donors may never know. That is the highest form of giving, and it is the highest honor we can receive as a partner in this endeavor.”

UK medical school at Bowling Green, similar to deal with Ashland and Morehead hospitals, is aimed at addressing doctor shortage

The Medical Center and Western Kentucky University
already cooperate on other medical-education programs.

Officials and civic leaders in Southern Kentucky have high hopes for a medical school partnership between the University of Kentucky, Western Kentucky University and The Medical Center at Bowling Green, Deborah Highland reports for the Bowling Green Daily News. UK has a similar partnership with King's Daughters Medical Center in Ashland, St. Claire Regional Medical Center in Morehead, and Morehead State University, also aimed at the state's physician shortage.

The Bowling Green deal "is poised to help alleviate a physician shortage in the region, allow WKU faculty access to medical research opportunities, demonstrate a community commitment to smart growth and help keep the area's best and brightest in Warren County," Highland writes. "Medical school students will attend classes here in Bowling Green in a building on the campus of The Medical Center. The medical degree will be conferred by UK, and a certain number of slots in the program here will be available first to WKU students," starting with 30 in 2018.

Dr. Don Brown, The Medical Center's director of medical education, told Highland, "It's not every day that you're able to get a medical school in your community and this is a big accomplishment. . . . The closest medical school to us is Louisville or Vanderbilt" University, in Nashville. "We lose a lot of pre-med students to medical schools and they go away. We know if a Kentuckian trains in Kentucky, he or she is likely to stay in Kentucky."

Connie M. Smith, president and CEO of Med Center Health, told Highland in an email that the school will be in "new construction" on The Medical Center campus, not in the Health Sciences Complex at WKU, which houses the university's nursing and physical-therapy programs.

"Kentucky, like many other rural states across the nation, faces a shortage of physicians who are desperately needed to care for our aging population," Smith said. "This problem will only increase in scope if creative solutions are not identified."

Smith added, "We are already witnessing a level of excitement and intrigue throughout our medical community in regards to this project. Most physicians feel a responsibility for training the next generation, and they take this responsibility very seriously. We believe the medical school will bring about an unprecedented level of commitment to delivering the best in evidence-based care to patients throughout our region."

WKU Provost David Lee said, "This is a part of the state that needs more doctors, and it needs more medical professionals of all kinds,"I think this is only going to enhance the health care that is available to citizens of south-central and Western Kentucky."

Legislator, citing rural doctor shortages, files bill to give physician assistants authority to prescribe controlled substances

A Republican recently elected to the state House has filed legislation that would allow physician assistants to prescribe controlled substances, something they can do in every other state beginning in January.

State Rep. Daniel Elliott

Rep. Daniel Elliott, R-Gravel Switch, says the bill would help relieve the doctor shortages in some rural areas of the state. “If we can give these professionals the ability to care for sick people then I can’t see why we wouldn’t do that in a state that tends to be at the bottom of some categories of health,” Elliott told Insider Louisville's Joe Sonka. “I don’t see the rationale in prohibiting very well educated and trained medical professionals from practicing medicine, and that’s what we’re saying they can’t do in Kentucky, to a certain extent.”

Physician assistants have two-year master’s degrees and are supervised by physicians. Kentucky has more than 1,200 of them. They have less prescribing authority in Kentucky than nurse practitioners, who have been able to prescribe controlled substances since 2006. Florida was the last state to extend the authority to physician assistants, effective in January.

"Ben Swartz, the executive director for the Kentucky Academy of Physician Assistants, tells IL that this difference makes it harder to hire physician assistants, and changing the law would 'bring parity in line with the two professions' and 'level the job market' in Kentucky," Sonka reports. "He adds that because Kentucky lags behind the rest of the country on this law, physician assistants in Kentucky often leave to find work in other states where they have full prescription authority, even though their training is more thorough than that of nurse practitioners."

Swartz acknowledges that the General Assembly has been reluctant to give PAs prescription authority "due to the state’s problem of prescription painkillers being over-prescribed and leading to opioid addiction and overdoses," Sonka writes. "However, he says this change would provide more accurate and responsible tracking of prescriptions by the state, as the supervising physicians’ prescriptions are often inflated when their assistant refers patients to them."

Elliott won a special election in March to fill the seat vacated by state Auditor Mike Harmon. Republicans are in the minority in the House but appear to have a good chance of winning a majority in the Nov. 8 elections.

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."

Baptist Healthcare gets USDA grant to buy telehealth equipment for rural hospitals and clinics in southeastern Kentucky

Baptist Healthcare System is getting a $182,566 grant from the U.S. Department of Agriculture to install teleconferencing and telehealth equipment for five facilities in medically underserved areas in southeastern Kentucky.

The grants from USDA Rural Development's Distance Learning and Telemedicine program will held Knox County Hospital, Pineville Community Hospital, and Baptist Health Richmond as well as primary care clinics in Williamsburg and London, reaching approximately 5,000 people, Baptist Health said.

Bevin says he will end all Obamacare programs in Ky., including Medicaid expansion that has added more than 400,000 to rolls

Matt Bevin, the Republican nominee for governor, has made clear that if elected he would end the Medicaid expansion that has provided free health coverage for more than 400,000 poor Kentuckians.

During his primary campaign, Bevin never made that quite plain, saying he would close the state's health-insurance exchange, Kynect, because it would cost "hundreds of millions of dollars." Kynect is paid for by insurance companies, so Bevin was alluding to to the state's projected cost of expanding Medicaid, which enrolls through Kynect.

The Washington-based publication Politico reported on June 10, after interviewing Bevin, that he would not only close Kynect but roll back the Medicaid expansion: “You may or may not have access to Medicaid going forward,” he said. “People are not on it for extended periods of time. It’s not meant to be a lifestyle. It really isn’t. The point of it is to provide for those who truly have need.”

Democratic nominee and Attorney General Jack Conway, with Gov.
Steve Beshear; GOP nominee Matt Bevin (AP photos via Politico)

Gov. Steve Beshear "is furious" about Bevin's plan, Politico reported. “I am not going to allow someone to become governor of this state who wants to take us back to the 19th century,” the governor said in a telephone interview. “For a serious candidate for governor to be advocating a simple repeal of the whole program without offering any kind of alternative which will continue health care for these people is irresponsible.”

Beshear expanded the eligibility rules for Medicaid as part of implementing the Patient Protection and Affordable Care Act, raising the income limit to the law's required 138 percent of the federal poverty level, from the state's previous level of 69 percent.

The federal government is paying the entire cost of the newly eligible Medicaid recipients though next year. In 2017, the state would begin to pay 3 percent, rising to the reform law's cap of 10 percent by 2020. A study by Deloitte Consulting and the Urban Institute at the University of Louisville  — "which Republican critics have rejected as spin," Politico says — has said the expansion more than pays for itself through 2020 by expanding health-care jobs and generating tax revenue.

Jobs are growing as projected by the study, according to the Cabinet for Health and Family Services, which handles Medicaid.

Cabinet spokeswomnan Jill Midkiff said the study estimated that 32,000 jobs would be created through 2015 as a result of the expansion. "U of L projected this growth would primarily be in the areas of retail trade, finance and insurance, administrative services, health and social services, accommodations and food services and other services," Midkiff said. "These sectors were estimated to account for more than 28,000 of the 32,000 jobs created." She said the latest Bureau of Labor Statistics figures show that "these sectors have grown by more than 29,000 jobs from 2013 until April 2015. Therefore, the most recent BLS numbers indicate that UofL’s estimates are on target to meet projections."

Politico says a Bevin victory could "blot an Obamacare bright spot," since Kynect has "worked virtually glitch-free." Through April, 106,000 Kentuckians had obtained tax-subsidized, private insurance coverage through Kynect, which is also the portal for enrolling in Medicaid.

Bevin says he would move those people to the federal exchange, which has been marred by technological issues and charges insurance companies much more to use it than Kynect does. But that plan would not work if the U.S. Supreme Court rules this month that the tax subsidies are not legally available through the federal exchange.

"That doesn’t worry Bevin," Politico reports, quoting him: “You’re worrying about a hypothesis. Let’s let the Supreme Court rule.”

And what about the new Medicaid recipients who would lose their benefits if Bevin wins? He "insists that Obamacare is coverage in name only — that Kentuckians still lack access to high-quality health care, partly because Medicaid pays doctors such low rates, partly because he says too many people rely on emergency rooms," Politico reports, quoting him: “Just having health insurance doesn’t mean you’re going to get health care.”

Attorney General Jack Conway, the Democratic nominee, declined Politico's request for an interview. Campaign spokesman Daniel Kemp said, “Jack wants to make sure that the hundreds of thousands of Kentuckians who now have health insurance through Kynect, especially kids, keep their health insurance — not play politics or push an ideology that’s out of touch with Kentucky’s values.”

Politico observes, "Conway is in the tricky spot of embracing Kynect while trying to keep his distance from Obama and Obamacare, a term that still generates ire among Kentucky residents. A September 2014 Marist [College] poll found that 61 percent of registered Kentucky voters had an unfavorable impression of Obamacare. Only 17 percent had negative feelings about Kynect."

Video streaming for consultation with doctors expands and becomes more popular; 2 Ky. insurers use it and another plans to

In the past, people had to go to the emergency room to receive medical attention if they required it outside the usual hours for doctors. Now telemedicine programs such as KentuckyOne Health's "Anywhere Care" and Anthem BlueCross BlueShield's "LiveHealth Online," Kentuckians can access a doctor 24/7 through a computer or mobile device.

Photo from The Lane Report

"Patients like telemedicine because it's fast and easy to use and cheaper because it's a low-overhead service," Esther Zunker writes for The Lane Report, a Lexington-based business magazine.

UnitedHealthCare, a Minnesota-based health benefits provider for many people in Kentucky, plans to cover Skype-based doctor visits through "NowClinic," "Doctor on Demand" and "American Well." Anywhere Care and Live Health Online give clients a list of certified doctors they can chat with through video on a computer or a mobile device. The doctors can provide diagnosis and treatment and even write a prescription. They can direct patients to an emergency department if necessary.

It's affordable, too. A LiveHealth Online appointment costs the same as an office visit for eligible members. LiveHealth doctors usually charge $49 per online "visit." Anywhere Care costs $35 per visit, even if patients don't have insurance.

"As we know, care can be limited and is based on being able to get someplace when [a doctor] has an opening," said John Jesser, Anthem's vice president of provider engagement strategy. "They only have certain hours, and that doesn't always work for when people don't feel well. [Telemedicine] expands access to care for the consumers, making it much more friendly to their schedule and lifestyles."

Telemedicine is also convenient for doctors. It saves money for hospitals and allows one doctor in one location to help patients in a variety of locations. Patients can receive help with chronic conditions over periods of time without having to travel to the doctor's office.

"We've had amazingly positive feedback from patients who have tried this service," said Kathy Love, director of strategy and business development for KentuckyOne Health's Central East Kentucky Market. "People have told me they've used it multiple times when they've needed it . . . either late at night or over the weekend."

She also said people who use telemedicine still need a primary-care physician: "It's something you can access 24 hours a day with a very minimal wait and very professional providers, but it shouldn't replace your very important relationship with your primary-care doctor." (Read more)

Senate OKs bill for review panels in medical lawsuits after lively debate between doctors, lawyers, others

This story, which was published Thursday morning, has been updated with action in the full Senate.
By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- The Senate has approved a bill that advocates say will help weed out "frivolous" medical malpractice lawsuits and speed up litigation for legitimate suits.

Alvarado

"Right now, Kentucky has one of the nations most litigation-friendly environments, making our commonwealth a prime and profitable target for personal injury lawyers preying upon our health care providers," Sen. Ralph Alvarado, R-Winchester, a physician and sponsor of Senate Bill 6, told the Senate Health and Welfare Committee. Opponents disputed that claim.

The Senate passed the bill Thursday 24-12. It is not expected to pass the House.

The bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court but not legally binding.

The Republican-controlled Senate passed a very similar bill last year but it got nowhere in the Democrat-controlled House, and its prospects are similar this time. However, Wednesday's committee meeting provided a detailed and lively explication of the issue, lasing almost two hours.

Vanessa Cantley, a Louisville personal injury attorney, told the committee that most medical malpractice cases are legitimate. She cited a Harvard University study published in the New England Journal of Medicine that concluded "portraits of a malpractice system that is stricken with frivolous litigation are overblown" and reported that 97 percent of claims for medical injury evaluated over a decade were deemed to be meritorious.

However, Michael Sutton of Louisville, a civil defense attorney, said defendants win 80 per cent of medical malpractice suits.

Cantley said there are 2,700 deaths in Kentucky each year due to purely preventable medical error, but, according to the state Department of Insurance, fewer than 500 lawsuits a year are filed by abuse and neglect victims. She spoke for the Kentucky Justice Association, formerly the Kentucky Academy of Trial Attorneys.

Alvarado and other opponents argued that Kentucky has become a haven for such lawsuits and bills like his have helped deter them. "Medical review panels are a proven solution for limiting baseless claims brought by a personal injury lawyer to ensure a faster, more efficient path for patients with legitimate claims, " he said.

Alvarado said the state is 4,000 doctors short of its need and the legal climate in Kentucky makes it hard to recruit and retain doctors. Sen. Julie Raque Adams, R-Louisville, the committee chair, said the expansion of Medicaid in Kentucky makes it all the more important to make the state attractive to doctors. "Anytime there's a paradigm shift, there are other policies that  need to go along with that paradigm shift," she said.

Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, said review panels "will stabilize our medical malpractice system and make our state more attractive" and "protect the legitimate cases while weeding out the meritless claims," which increase costs to consumers and employers through higher premiums and defensive medicine in the form of extra medical tests.

Kentucky's constitution bans laws that would cap damages

in lawsuits. (Care First Kentucky graphic)

Every state surrounding Kentucky offers some level of protection against medical malpractice, while Kentucky offers no legal protections for healthcare providers, according to Care First Kentucky, a business coalition supporting the bill.

Sen. Reggie Thomas, D-Lexington, a lawyer, argued that Kentucky already has laws to punish attorneys for filing frivolous cases. Alvarado said the rule isn't used much because judges "allow a lot of latitude," and Sutton said it is reserved for "really egregious conduct."

Cantley argued, subtly, that courts are the refuge for patients who suffer from abuse, neglect and malpractice. She said the federal Centers for Medicare and Medicaid Services has ranked Kentucky No. 1 in nursing-home deficiencies, and argued that state boards that discipline doctors do a poor job.

The full Senate's debate on the bill was cut short because the committee adopted a substitute version, preventing Democratic Leader Ray Jones of Pikeville, a plaintiffs' lawyer, from offering any of his amendments, which had been drafted to the original bill. Under traditional procedures, a bill gets its required readings on days between the committee meeting and the floor vote, but in recent years Republicans have given important bills readings before committee action, allowing a vote on them the day after they pass a committee.