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.

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."

Here's a sampling of views from health-care providers about health care and health in rural Kentucky

Louisville-based Medical News recently interviewed five health-care providers in Kentucky about the challenges that face rural health care: "Economic factors, cultural and social differences, educational shortcomings, sheer isolation with limited access to transportation and lack of recognition by legislators." Here are some excerpts:

Poverty and drugs compound each other, said Dr. Philip Hurley of Owensboro: "Whereas these addictions can affect all socioeconomic brackets, the effects on the poor tend to be more devastating as family and public support are often not as readily available. Obesity is another challenge. Sadly, our country has the dubious distinction of being the first country in history where the poor are obese."

Some noted the difficulty of attracting health-care providers to rural areas, but Dr. LaTonia Sweet of Molina Health in Louisville said, "Nowhere else can a physician use the same depth and breadth of skills needed as in rural healthcare. A physician can make a huge impact on the health of a community in rural areas."

"Rural areas work continuously to recruit talent for health-care delivery," said Dr. Brent Wright of the University of Louisville. "In addition to recruitment issues, there are continuous regulatory and technology demands that strain existing resources (electronic medical records, quality initiatives and value-based care). These initiatives drain resources from shrinking margins."

Hurley said electronic health records and telemedicine have helped rural Kentucky, "but most EHR records are close to garbage. It is often very difficult to glean useful, pertinent information. The electronic imaging and the ability to view it remotely is helpful."

Wright was more optimistic: "Telemedicine will see a resurgence as we all become more mobile through our smart devices. Brick and mortar healthcare will not be as necessary as bandwidth and connectivity increases. This is great for rural health because it means less travel and more access."

Asked what changes they would like to see to improve health care in rural Kentucky, Susan Starling of Marcum and Wallace Hospital in Irvine said "improved access to mental health, which has become very centralized in the urban areas; local access to alcohol and drug treatment centers; and support of critical access hospital programs and other federal programs that support rural health care."

Dr. Patrick Withrow of Paducah said he has been shocked by high suicide rates among farmers and other rural residents, which "need to be addressed. The wide geographic population and resultant limited mental and medical health resources in rural areas is a problem. Telemedicine may be a way to improve access to care. Also, the expansion of medical training to the more rural areas (Morehead, Bowling Green, Glasgow and northeast Kentucky) will improve access to care."

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."

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."

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.

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.

Ky. is already short of doctors, dentists; how will its health-care system handle expansion of Medicaid and private insurance?

By Molly Burchett and Al Cross
Kentucky Health News

In the wake of Gov. Steve Beshear’s recent decision to expand Medicaid under federal health reform, there is concern that Kentucky's health-care system will not be able to care for the newly insured.

Health reform means that an estimated 308,000 new Kentuckians will qualify for Medicaid, and 332,000 more will qualify for subsidies to buy private insurance through the state insurance exchange that will start taking enrollments Oct. 1.

But Kentucky already has a health care provider shortage, especially in rural areas. A study for the state estimates that it needs 3,790 more doctors just to meet current demand, to say nothing of what will be needed to care for those who haven't been a regular part of the health-care system, reports Laura Ungar of The Courier-Journal.

The report by Deloitte Consulting made 11 recommendations, including authority for nurse practitioners to prescribe less risky drugs without a written agreement with a doctor, and one that would be even more controversial, putting limits on medical malpractice awards, said Ungar.

The report also recommended expanding and increasing Medicaid reimbursements in rural areas, to encourage more physicians to take Medicaid patients.

It did not mention complaints by health-care  providers about getting paid by the managed-care Medicaid system that the state began in November 2011; Gov. Steve Beshear said when he announced Medicaid expansion that those problems are being worked out.

"Consultants said 61 percent of the 3,790 'full-time equivalent' physicians needed (which includes primary care doctors and specialists) were in rural counties," reports Ungar. Jonathan Felix of Deloitte said, “Primary care, dental care and behavioral health are all big needs in the state.”

The report said the state needed 183 more primary-care doctors, even before Medicaid expansion, but a 2012 Kentucky Physician Workforce Needs Assessment report by the University of Kentucky said the state needs 557 more primary-care physicians and 1,655 more total physicians to meet the national ratios for physicians to population.

The consultants said the state already needs 612 more dentists. It now has 1,711.

Complicated provider shortage problem, no easy answer

About 192 federally identified areas in Kentucky — including 47 counties — have shortages of health professionals, Ungar reports. Kentucky counties who will have the most non-elderly residents eligible for Medicaid often have fewer primary-care doctors per person, according to data analyzed by The Courier-Journal. Ungar notes that Casey County, for example, ranks in the bottom third for doctors per capita, but it has the highest portion of newly eligible residents at 13.5 percent.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” Susan Zepeda, president and chief executive officer for the Foundation for a Healthy Kentucky, told Ungar.

Nationally, there is a primary-care shortage, partly because such doctors make less money than most, and low reimbursement rates exacerbate that. A 2012 study in the journal Health Affairs said 21 percent of office-based physicians in Kentucky did not accept new Medicaid patients in 2011, Ungar notes.

The health reform law will raise the Medicaid fees to match what Medicare pays primary-care doctors, but only for two years. Kentucky's Medicare rates are about 72 percent of the Medicare rates, compared to a national average of 59 percent, says an Urban Institute study. But the time limit leaves some practitioners wary.

“If I choose to increase the number of Medicaid patients, and two years down the road that payment drops back to two-thirds, all of a sudden I’m going to have an awful lot of trouble keeping my doors open,” Reid Blackwelder, a family practitioner and incoming president of the American Academy of Family Physicians, told Michael Ollove of Stateline. 

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness, particularly in Kentucky and other states that are expecting the largest percentage increases in Medicaid enrollees and that have low numbers of primary-care physicians.

“I’m not sure who’s going to pick up all those patients into their practices,” Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, told Ungar. Legislation to let nurse practitioners prescribe non-scheduled drugs without a doctor agreement failed in the state Senate this year.

While some policy analysts have touted nurse practitioners as a solution to the rural primary-care shortage because they often provide primary care in rural and isolated areas that do not have doctors nearby, they would not be covered by the two-year reimbursement increase. Ewen said the reimbursement is only $23 for a lower-level visit by an established patient.

A possible long-term solution includes greater reliance on community health centers, some say. And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, said her system is looking to open new primary care offices and hire more staff.

Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from its new partner, KentuckyOne, to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agree that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it. The state estimates that 188,000 of the 308,000 newly eligible will enroll, but some think that estimate is low.

U of L's Trover medical campus ranked among best for rural medicine education and addresing rural physician shortage

The University of Louisville School of Medicine Trover Rural Campus in Madisonville was rated third best in the nation for preparing medical students to practice in rural areas, which is critical to the state since most of Kentucky's rural counties are considered to be short of health professionals.

“From the president and the deans to the individual faculty and staff, our team has proven the value of a collaboration of a rural campus and an urban university. The beneficiaries are our students and the rural Kentucky communities who receive these new doctors who are well prepared to care for them,” Dr. Bill Crump, right, associate dean for the Trover campus, said in a UofL press release.
  
The study by researchers at the University of Colorado, which will be published in Academic Medicine in August, ranked 35 programs across the nation and found that 62 percent of Trover graduates practice medicine in rural areas, says the release.

“This national recognition is the fulfillment of Dr. Loman Trover’s vision outlined almost 60 years ago of providing first class medical education in a small town with the goal of producing more physicians for rural Kentucky, and is a testament to the strong support we’ve had from the Louisville Campus over the past 15 years,” said Crump.

Nationally, there is a physician shortage in rural areas because only 3 percent of medical students report want to practice rural medicine, while 16 percent of Americans live in rural areas. This problem is especially large in Kentucky, says the release, since a majority of the state's 59 counties classified as rural are considered to be short of medical professionals..

“Our Trover campus is vital to fulfilling this mission and especially critical now because our state faces such a significant shortage of physicians, especially in rural areas. Dr. Crump’s leadership of the program is one of the reasons for its success. We view the program as a model that has the potential to be implemented in other areas of Kentucky,” said School of Medicine Dean Dr. Toni Ganzel.

Health reform expected to hurt recruitment of rural doctors

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

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

New health law and aging baby boomers' anticipated strain on the system is about to make chronic doctor shortage worse

Kentucky's persistent physician shortage is hardly new. Almost a century ago, the Frontier Nursing Service came to Hyden on the presumption that doctors wouldn't. A report from the Health Resources and Services Administration in 2005 found that 81 of 120 of the commonwealth's counties were officially health professional shortage areas. Now comes news that areas in the United States with growing and dense urban populations are feeling the considerable pinch of also not having enough doctors to provide care.

New York Times reporters Annie Lowrey and Robert Pear report that with the expansion of insurance coverage and aging baby boomers driving up demand, we shouldn't expect the shortage to get better anywhere before it gets worse everywhere. (NYT chart)


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

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

Doctors shifting from private practice to large hospitals for more security under health-care reform

Associated Press photo by Michael Schennum.

The days of hanging up a shingle and opening shop are becoming more and more unusual for doctors. Afraid of being left without protection in the face of changes caused by federal health-care reforms, doctors are leaving their private practices and moving under the shelter of large hospitals.

The shift is "driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers," reports J.D. Harrison for The Washington Post. In general, large hospitals have more financial security and are more equipped to keep track of new regulations.

In 2000, 57 percent of physicians owned their own firms compared to 43 percent in 2009, research by Accenture shows. The number is expected to fall to 33 percent by 2013. "The classic model of independent, small physician practice still exists today, but it's rapidly becoming a relic of a bygone era," Mark Smith, president of physician-recruiting firm Merritt Hawkins, told the House Small Business Committee last week. "This model is only likely to persist in any numbers in smaller, rural areas where there are few physicians; and even here, physicians will likely need to partner or affiliate with larger entities in some way."

Part of the change stems from the fact that accountable-care organizations are now an official part of Medicare. This health-care model, in which groups of providers "take responsibility for the care for an entire patient group," encourages hospitals to take on physician partners, Harrison notes. "Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary-care physicians, particularly, as well as specialists that they can have in their accountable care organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.

New regulations and non-compliance penalties that are built into the law are also making doctors run for cover. "There is so much more regulation, and the penalties are so great, physicians are very fearful that they'll make an honest mistake and be held financially accountable," Smith said. (Read more)
Hat tip to The Lane Report

More foreign-born doctors practice in rural areas, come from poor nations; Kentucky is about average, West Virginia is high

More than 15 percent of physicians in the U.S. received training in lower-income countries, including India, Pakistan and the Phillippines, a new study has found, reports Lori Kersey of The Charleston Gazette. The study was a joint effort by the National Research Council and the Stanley Medical Research Institute, and was published online on PLoS ONE.

Most doctors from low-income countries practice in low-income areas of the U.S., where most U.S.-trained doctors don't usually want to go. West Virginia has the most such doctors, at 29 percent all of physicians in the state. Kentucky has 16 percent, just above the national average of 15.4 percent. Montana, Idaho and Alaska all have less than 2 percent.

The authors of the study said low-income countries that send most of their doctors to the U.S. lost more money training them than they receive in U.S. foreign aid. In 2010, the Phillippines spent $1.7 billion training more than 20,000 doctors who then came to the U.S., but was only given $33 million in U.S. foreign aid. The authors suggest the U.S. should pay those countries back in some way. (Read more)

Rural hospitals to get federal help for recruiting physicians

Critical-access hospitals will get help recruiting physicians to their rural areas through an expanded loan repayment program that is part of President Obama's new jobs initiative for rural America.

The initiative is called the National Health Service Corps, Alexandra Wilson Pecci of HealthLeaders Media reports. The 1,300 critical-access hospitals can use federal loans to recruit new physicians. A press release from the White House states the addition of one primary care physician in a rural community generates about $1.5 million in annual revenue and creates 23 jobs annually.

Kentucky has 30 critical-access hospitals, which must be in rural areas, 35 miles from another hospital or 15 miles from another hospital in mountainous terrain, according to the Rural Assistance Center. The average CAH creates 107 jobs and generates $4.8 million in payroll annually, the White House says.

The jobs program also includes an agreement that will "link rural hospitals and clinicians to existing capital loan programs to help them buy health IT software and hardware and jump the typical rural hospital hurdle of limited access to capital and lower financial operating margins," HealthLeaders Media reports.

A few days before announcing the jobs program, the White House Rural Council released a report that outlined recent investments in rural healthcare access. Those include placing more than 2,600 clinicians in rural communities and providing distance learning and telemedicine services to more than 2,500 rural healthcare and educational facilities. It also highlighted an investment of 500 projects across the U.S. Department of Veterans Affairs health care system that support rural health care. That includes 404 community-based outpatient clinics and 48 outreach clinics in rural areas.

On average, rural counties had 62 primary care doctors for every 100,000 residents in 2008, compared to 79.5 primary care doctors in urban areas, the Rural Council report said. (Read more)