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UC Davis Will Target Rural Needs: Fears of a Nationwide Doctor Shortage Galvanize U.S. Medical Schools

Posted on: Wednesday, 14 June 2006, 15:01 CDT

By Carrie Peyton Dahlberg, The Sacramento Bee, Calif.

Jun. 14--UC Davis Medical School has been admitting exactly 93 would-be doctors every year for more than a generation.

Now, for the first time since 1971, the university is poised to boost medical enrollment through a program to train doctors who want to live and work in rural communities.

The effort is part of an ambitious plan to expand each of the five University of California medical schools and perhaps create a sixth amid predictions of a nationwide doctor shortage.

Those predictions have galvanized U.S. medical schools, with more than 40 percent reporting that they're likely to increase admissions in the next five years, according to an Association of American Medical Colleges survey.

This week, the association is expected to recommend 30 percent enrollment increases in the next decade.

The trouble is, no one knows how to open the biggest bottleneck in licensing more doctors -- figuring out who will pay for the added doctors-in-training during their residencies.

"We're scrambling, we are literally scrambling very hard," said Dr. Richard Hart, chancellor of Loma Linda University, which hopes to hike medical school admissions by 25 percent over about seven years.

"We're talking about pushing residents outside the state, trying to create satellite campuses," and searching for other options, Hart said.

Doctors cannot be licensed until they've been supervised for three or more years in grinding residency programs at the hospitals they serve.

Yet, no one has begun to seriously address how to expand funding to match the greater number of residents.

"Really very little thought as far as I can see has gone into that yet," said Edward Salsberg, director of the medical colleges association's Center for Workforce Studies.

To ensure that the anticipated new wave of graduates translates into more doctors, the association wants Medicare to lift its 1997 cap on how many residents it will support at each hospital.

Although the federal program's main mission is providing insurance for older and disabled Americans, it has long helped hospitals pay the salaries, benefits and even malpractice insurance for about 80 percent of U.S. medical residents.

Some positions are also funded by the Department of Veterans Affairs and by teaching hospitals.

Although California universities, the medical college association and others are expected to lobby Congress to lift the cap, there may be a limited appetite for boosting the $8.2 billion that the financially strapped Medicare program now spends each year to support residents.

Dr. Kevin Grumbach, chairman of the family and community medicine department at the University of California, San Francisco, foresees chilling possibilities. Private money may flow to train more specialists in a hospital's high-profit areas, while less profitable training may be neglected.

"It's very high-end specialty care that is making hospitals money these days ... radiology, anesthesiology, surgical subspecialties," Grumbach said. "The tragedy in all this is we're about to have the bottom fall out in residency training for primary care."

Grumbach is among those skeptical of predictions of a looming doctor shortage, pointing out that the number of doctors per capita in California is expected to increase for the next five to 10 years. The shortage forecasts are based on complex assumptions involving physician retirements, workload, population health and other factors that could evolve in ways no one now foresees.

Other predictions have gone awry. In the late 1970s and early 1980s there were widespread warnings of a doctor surplus so severe that UC medical schools were told to slash enrollments by 5 percent to 7 percent.

Yet whether the nation as a whole ends up with too few doctors or too many, no one disputes that America is plagued with pockets of shortages, where care remains hard to come by.

As it begins to expand, the University of California wants to first address those pockets, asking each of its five medical schools to develop programs tailored to train doctors who want to treat underserved populations.

"The goal is improved access to better care with better outcomes," said Dr. Cathryn Nation, executive director of academic health sciences for the UC system.

UC Irvine began in 2004 focusing on training more Spanish-speaking doctors. UCSF is developing a pilot program for doctors who want to treat the homeless, runaway teens, the working poor and other underserved city dwellers. UC San Diego will focus on health disparities among different racial and ethnic groups, and UC Davis on rural medicine.

That program, which could admit an extra 10 to 12 aspiring doctors in 2007, seemed a natural fit for UC Davis, said Dr. Tom Nesbitt, an executive associate dean.

"We are the northernmost academic medical center," he said. "Between Sacramento and the Oregon border is an area the size of many states, and we feel we have an obligation to the rural communities there."

It seems like a natural fit, too, for Maureen Cahill, who just wrapped up her second year in medical school at UC Davis and thinks it would be "awesome" for the campus to train more rural doctors.

Cahill grew up in Loleta, a tiny Humboldt County town she describes as surrounded by rolling hills and dairy farms, with commerce limited to a couple of general stores and a cheese factory.

"I had a lot of friends growing up who didn't have dental care and who were sick all the time and couldn't go to the doctor," she said.

Her mother, a social worker, constantly was searching for ways to help older people deal with long drives over dirt roads to get the care they needed to keep living independently at home.

Cahill wants to care for people in a rural coastal community like the one she was raised in, where poverty, isolation and lack of insurance make the need for more doctors especially critical.

How many people follow her into rural practice -- or practice in other areas where care is scanty -- will depend in part on whether UC can fulfill its hopes of making its initial expansion a magnet to draw more doctors into underserved fields.

It will also depend on whether UC can follow through on its plans to expand the residency slots it oversees by 150 to 200 first-year positions, as much as 20 percent above its current 1,000.

Nation, the UC health sciences executive, has just begun investigating ways to get Medicare or other funding to pay for those additional doctors in training.

It's too early, she said, to know where those investigations will lead.

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Copyright (c) 2006, The Sacramento Bee, Calif.

Distributed by Knight Ridder/Tribune Business News.

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Source: The Sacramento Bee

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