Opportunities for medical students might fix Indiana health shortages

Although a physician shortage has been predicted across the United States, trends are beginning to show more medical students are pursuing primary care residencies, according to the Association of American Medical Colleges.  

Indiana ranked 37th in the U.S. with 70.3 active primary-care physicians providing direct patient care per 100,000 residents, according to a 2009 study conducted by the AAMC. 

“There’s going to be funding for primary care,” said CEO of the Indiana Primary Health Care Association Phil Morphew. “But now we have to find the people to provide the care.”

The number of primary-care physicians graduating from the IU School of Medicine began to decline in 1998 and continually remained at lower rates of around 40 percent for the past six or seven years, director of medical student records Dennis Deal said.

This year, however, the rate of IUSM students going into primary care has risen to 47 percent, Deal said. This was the first time since 1998 that rates increased significantly.

“I don’t know if it’s a trend or not, but it does echo national figures,” Deal said. “We hope it’s a trend because it is the school’s mission to provide enough health care providers to the state.”

The idea is to increase the reimbursement rates for primary-care doctors who practice preventative care, Dr. Aaron Carroll, pediatrics professor at IU’s School of Medicine said.

If there is an increase in reimbursement rates, primary care will become more attractive to medical students, Carroll said.

In 2011, primary-care doctors will receive a 10 percent increase in their Medicare reimbursement rates. The bonus payments will continue for five years.

In 2013 and 2014, primary-care physicians will receive increased Medicaid reimbursement rates that will pay the same amount as Medicare.

Along with higher payment rates, there will be an increased number of financial aid opportunities for medical students pursuing primary care.

Many medical students choose not to go into primary care because of the fact that they graduate with large amounts of debt and primary care practice pays less than specialty care, Carroll said.

The average debt of IU School of Medicine students is about $168,000 for 2010, said José Espada, IUSM’s director of financial aid.

Medical students who work in federally qualified health centers, community mental health centers or critical access hospitals will be able to have their education partially funded by the federal government, Morphew said.

According to Morphew, the health care legislation will substantially increase funding for the National Health Service Corps, a program within the United States Department of Health and Human Services that provides scholarships and loan payments to clinicians who work in a Health Professional Shortage Area for at least two years.

The income-based repayment program will be lowering the amount of loan payments students will have to make from 15 percent to 10 percent of their annual gross income as a result of health care reform, Espada said. 

IBR loan payment rates will decrease in July of 2014 when the health care reform law goes into effect, Espada said.

Through the increase in funding, a larger number of graduating physicians who go into primary care will be able to have some of their medical education fees reimbursed, Morphew said.

Espada said that with the decrease in IBR loan payment rates and a federal Public Service Loan Forgiveness Program, the amount of debt will not be as much of a concern for students pursuing primary care in the future.

“It’s been a long time since we’ve seen any increase in the number of primary care graduates, but we have seen now the pendulum swing going in the other direction this year,” Espada said.