Remedy for rural doctor shortage is in test stage

 Boston Globe | By Darryl Fears |  August 15, 2010

ESMONT, Va. — Sarah Carricaburu slipped her sleek new iPhone into her purse for the day. With no signal here deep in the woods, it is useless. She swiveled away from her desktop computer, which cannot use the Internet, and glanced at the manila folders of patient records neatly stacked on a shelf by nurses.

“I grew up in the age of electronic medical records,’’ said Carricaburu, 33, a primary care physician who was raised in the Washington suburbs. “Coming here was like stepping back in time. I would like to stay in a community health care setting, but here I didn’t feel like I had the resources to do my job. You’re cut off.’’

Carricaburu’s choice of whether to stay or go is not just about her own career satisfaction. Her 12 colleagues at the Southern Albemarle Family Practice have a vested interest in her staying on, as the clinic’s director and its one full-time physician, beyond the three years that she is under a contract with the federal government that will help pay off school loans.

She is also a test case for the Obama administration’s goal, under the new health care law, to bring thousands of young primary care doctors to underserved areas such as this unincorporated town of 1,200 and keep them there.

The administration recently invested more than $1 billion from the stimulus and the health care law into the National Health Services Corps to beef up doctor recruitment. It’s more money than the 40-year-old agency has ever had, said Rebecca Spitzgo, associate administrator for the Bureau of Clinician Recruitment and Service.

Nearly 5,000 recent medical school graduates accepted federal grants to pay off tuition and school loans averaging $150,000 per student. The awards come with contracts that obligate the young doctors to remain in what are typically rural areas for three to five years. The corps hopes to recruit another 2,800 students next year. A report by the corps’ advisory council estimated that 27,000 primary care physicians are needed to meet the needs of about 45 million Americans in medically underserved areas.

But after facing decisions similar to the one Carricaburu is weighing, several young doctors who were interviewed said they are struggling with whether to spend a career in rural settings. Experts said they expect retention to be a problem.

Carricaburu was one of two in her class at Northwestern University’s Feinberg School of Medicine who chose to become a family practitioner rather than one of the high-wage specialists the school is known for.

She made that choice despite the stigma that others attach to students who choose family medicine. “When I told one of my professors that it was what I wanted to do, he said, ‘You’re too smart for that.’ ’’

But Carricaburu had a mission. “I just always felt that I really wanted to help people who wouldn’t otherwise get help,’’ she said.

But she was unprepared for the daily inconveniences of rural living: well water in the clinic’s kitchen sink that smells of rotten eggs; being unable to use the iPhone’s Epocrates app, which helps doctors identify and prescribe medicine; the dial-up Internet that crawls along on a single computer shared by the clinic; the 40-minute drive to a grocery store; the lack of dating potential. The National Health Service Corps should make rural offices more friendly to technologically savvy young doctors if it want them to stay, she said. 


http://www.boston.com/news/health/articles/2010/08/15/remedy_for_rural_doctor_shortage_is_in_test_stage/

Issues: 

 Boston Globe | By Darryl Fears |  August 15, 2010

ESMONT, Va. — Sarah Carricaburu slipped her sleek new iPhone into her purse for the day. With no signal here deep in the woods, it is useless. She swiveled away from her desktop computer, which cannot use the Internet, and glanced at the manila folders of patient records neatly stacked on a shelf by nurses.

“I grew up in the age of electronic medical records,’’ said Carricaburu, 33, a primary care physician who was raised in the Washington suburbs. “Coming here was like stepping back in time. I would like to stay in a community health care setting, but here I didn’t feel like I had the resources to do my job. You’re cut off.’’

Carricaburu’s choice of whether to stay or go is not just about her own career satisfaction. Her 12 colleagues at the Southern Albemarle Family Practice have a vested interest in her staying on, as the clinic’s director and its one full-time physician, beyond the three years that she is under a contract with the federal government that will help pay off school loans.

She is also a test case for the Obama administration’s goal, under the new health care law, to bring thousands of young primary care doctors to underserved areas such as this unincorporated town of 1,200 and keep them there.

The administration recently invested more than $1 billion from the stimulus and the health care law into the National Health Services Corps to beef up doctor recruitment. It’s more money than the 40-year-old agency has ever had, said Rebecca Spitzgo, associate administrator for the Bureau of Clinician Recruitment and Service.

Nearly 5,000 recent medical school graduates accepted federal grants to pay off tuition and school loans averaging $150,000 per student. The awards come with contracts that obligate the young doctors to remain in what are typically rural areas for three to five years. The corps hopes to recruit another 2,800 students next year. A report by the corps’ advisory council estimated that 27,000 primary care physicians are needed to meet the needs of about 45 million Americans in medically underserved areas.

But after facing decisions similar to the one Carricaburu is weighing, several young doctors who were interviewed said they are struggling with whether to spend a career in rural settings. Experts said they expect retention to be a problem.

Carricaburu was one of two in her class at Northwestern University’s Feinberg School of Medicine who chose to become a family practitioner rather than one of the high-wage specialists the school is known for.

She made that choice despite the stigma that others attach to students who choose family medicine. “When I told one of my professors that it was what I wanted to do, he said, ‘You’re too smart for that.’ ’’

But Carricaburu had a mission. “I just always felt that I really wanted to help people who wouldn’t otherwise get help,’’ she said.

But she was unprepared for the daily inconveniences of rural living: well water in the clinic’s kitchen sink that smells of rotten eggs; being unable to use the iPhone’s Epocrates app, which helps doctors identify and prescribe medicine; the dial-up Internet that crawls along on a single computer shared by the clinic; the 40-minute drive to a grocery store; the lack of dating potential. The National Health Service Corps should make rural offices more friendly to technologically savvy young doctors if it want them to stay, she said. 


http://www.boston.com/news/health/articles/2010/08/15/remedy_for_rural_doctor_shortage_is_in_test_stage/