"The shortage of primary care physicians has reached a critical level. Over 20 percent of the U.S. population lives in rural areas, yet they are served by only nine percent of the nation's physicians.  This shortage jeopardizes the nation's ability to meet the health care needs of the rural population and the discrepancy is expected to increase in coming years," said Melissa Loftis Florell, author of the report and a health policy intern with the Rural Research and Analysis Program at the Center for Rural Affairs.

A full copy of the report can be viewed and downloaded at: http://files.cfra.org/pdf/HealthCare_Workforce.pdf

According to Florell, multifaceted and multidisciplinary strategies are crucial to meet the needs of rural residents and to deliver health care that has the greatest potential to enhance wellness. Nurse practitioners and registered nurses can play a primary role in this type of care delivery. Nurse education focuses on the care of the person in the context of their environment, and places a high priority on wellness and health maintenance. Nurses have traditionally served as patient educators and advocates. These roles are central to safe, effective primary care, and serve as a natural bridge for increased rural practice.

"While it is clear that the supply of rural primary care providers of all classifications need to be increased, it is equally essential that health care reform creates a framework for innovative ways of meeting the health care needs of rural residents. Nurse practitioner-led primary care, including health care homes is one option. Another is built from the health care home model described by the Institute of Medicine to develop telehealth care homes in rural and remote areas. Building a framework and funding for these care delivery methods into health care reform can positively impact the availability of primary health care in rural areas while potentially improving the health of rural residents and rural communities," Florell added.

The report identifies a legislative initiative, SB 790, in the U.S. Senate that seeks to increase the supply of rural health care professionals, including nurses and nurse practitioners.  The "Health Access and Health Professionals Supply Act of 2009" - introduced by Senator Bingaman of New Mexico - employs a variety of measures to provide opportunities, financial assistance, and incentives for health care practice in rural areas. Provisions of SB 790 that the report calls "encouraging" include:
 

• Creation of a permanent National Health Workforce Commission to design, coordinate, and implement federal grants and regulations aimed at providing quality health care access to all areas of the country.

• Grants to create a "pipeline" of middle and high school students interested in studying health care-related fields, with a priority to schools in health professional shortage areas, and creation of the infrastructure for partnerships between schools, medical professionals, medical associations and non-profits. This is similar to the AHEC model discussed previously

• Increased funding for the National Health Service Corps to provide additional scholarships and loan repayments for students in rural, frontier, and urban underserved areas.

• Clarification of existing law to ensure that participants in the corps and other federal loan-repayment programs for health professions can have their loans repaid without tax consequences.

• Creation of a U.S. Public Health Sciences Track at selected universities across the nation to train health care professionals, including nurses, physician assistants, dentists, pharmacists and mental health providers. Priority would be given to applications of students from rural areas. Students in this program would receive scholarship funds for each two-year commitment he or she agreed to serve rural communities in the new Commissioned Corps of the Public Health Service. Grants would be provided to schools to build capacity for the additional students (including developing curriculum, faculty recruitment, training and retention, and student financial assistance).

• Expansion of the Medicare medical home demonstration project to include a pilot program of 1,000 medical home primary care providers working in interdisciplinary teams.

• Loans and grants to help hospitals in underserved rural areas start community-based training for health care professionals in high need.

As Congress develops health care reform legislation they should include SB 790 or similar provisions for the benefit of rural people and rural communities.

This is the sixth in a series of Center for Rural Affairs reports examining crucial health care issues in rural America.  Previous reports can be found on the front page of the Center's website (www.cfra.org).