Missouri Health

A new report from the Missouri Hospital Association finds that the age, number and type of primary care providers in rural Missouri will present future challenges to rural residents’ access to health services and have negative consequences for rural health improvement efforts. The report includes an analysis of the state’s current rural physician workforce, the projected impacts of federal health reform on rural health care and policy options for strengthening the rural health care workforce.

Much of Missouri is designated as a primary care health professional shortage area, with one in five residents living in those areas, according to criteria established by the U.S. Health Resources and Services Administration. The shortage is particularly acute in rural areas, where there is one primary care physician for every 1,776 Missourians. In the state’s metropolitan areas, the rate is one primary care physician for every 962 citizens.

The age of the rural physician workforce is a concern, as well. Missouri’s rural primary care physicians on average are older than their metro-area counterparts. In Missouri, 55 percent of all physicians are 50 and older. In rural areas, the percentage of rural physicians 50 and older is 62 percent.

The research suggests that replacing aging rural primary care physicians will be especially difficult — their incomes are approximately 5 percent less than those in urban areas, they work longer hours, see more patients and see more Medicaid patients. This problem is amplified by research from the Association of American Medical Colleges which predicts a national primary care physician shortage of 45,400 by 2020.

“We have far fewer primary care physicians in our state’s rural areas, and they tend to be older,” said Herb B. Kuhn, MHA president and CEO. “There is certainly an identified problem in the rural physician workforce. This study is a first step in identifying the situation and potential options.”

An inflow of newly insured through the federal health care reform law is predicted to add 32 million previously uninsured individuals by 2019. In Missouri, it is estimated that approximately 500,000 individuals will become insured through Medicaid expansion and the implementation of health insurance exchanges. In addition, Medicare eligibility for Missourians ages 65 and older will continue to stress the system. In 2010, 14 percent of Missourians were 65 and older, and long range projections show continued growth in Missouri’s population of aging residents.

According to a recent health ranking, Missouri is 39th of all 50 states in all overall health standing in 2010. Reduced access to primary care can translate into poorly-managed chronic conditions and increased health care costs. Just 5 percent of the population is responsible for 50 percent of all health care spending. Primary care physicians play a crucial role in the diagnosis and treatment of chronic disease — a role critical to reducing Missouri’s health care spending.

“Missourians are self-reliant, and addressing the problem requires solutions that work for Missouri,” Kuhn said. “We’re going to have to innovate and invest in the correct people and technology to bridge the gaps between the numbers of Missourians seeking care and providers available to offer care. However, the ongoing discussion in our nation’s capitol on the federal budget could severely limit our options. Cuts to both Medicare and Medicaid would add considerable stress to the delivery of care in rural Missouri and hamper efforts to recruit, train and place primary care physicians in our state.”

The report provides several policy options for consideration. Cost is one of the major considerations for medical students choosing specialty physician training over primary care. Programs similar to the state’s Primary Care Resource Initiative for Missouri could help offset some of the costs incurred by medical students who might otherwise choose primary care in a rural setting.

The report also suggests that stronger science-based programs in rural primary and secondary schools may prepare more students from rural areas with the necessary prerequisites and motivation to pursue medical education and return to a rural care setting.

“Rural Missourians tend to be older and have higher rates of chronic diseases such as heart disease and cancer,” Kuhn said. “Primary care physicians are on the front line of health improvement and are essential to managing chronic conditions. Without a strong primary care workforce, Missouri’s health status in rural areas will deteriorate, along with the economic vitality of our rural communities.”

The Missouri Hospital Association is a not-for-profit membership association in Jefferson City that represents 151 Missouri hospitals. In addition to representation and advocacy on behalf of its membership, the association offers continuing education programs on current health care topics and seeks to educate the public, as well as legislative representatives, about health care issues.