As many as 20% of Michigan adults and 8% of children don’t have a primary care physician — a situation expected to worsen in the years ahead as a doctor shortage intensifies, according to a new report from the Milbank Memorial Fund, a nonpartisan foundation that centers its work on health policy.
Without enough family medicine doctors, Michiganders aren’t getting the care they need to manage conditions like diabetes and high blood pressure or to prevent future illnesses with screenings and treatments that can reduce hospitalizations and emergency department visits.
“We are 862 primary care physicians short in Michigan, and that's just to maintain the status quo,” said Dr. Julie Phillips, chair of family medicine at Michigan State University's College of Human Medicine, citing recent data from the Robert Graham Center, a health policy think tank.
“About 3 million Michigan residents are underserved in terms of access to primary care.”
Why does Michigan have a shortage of family medicine doctors?
It’s a problem driven by a number of factors. Among them is that newly trained family medicine physicians aren’t entering the field in high enough numbers to replace doctors who are retiring or leaving the state to practice elsewhere.
“When it comes to family medicine, specifically, 1 in 8 medical students enter family medicine residencies every year, but the ratio needs to increase to 1 in 4 in order to help stop the primary care doctor shortage,” said Dr. Jean H.C. Wong, an assistant professor at the University of Michigan and program director of its Family Medicine Residence Program.
Many who do choose primary care may later narrow their focus, subspecializing in nephrology or infectious disease and no longer offer primary care, Wong said.
“Part of the problem is that traditionally, Michigan loses more than half of our resident trainees to other states. And while we do gain some physicians from other states, it's at a lower rate,” Wong said.
Why aren’t more doctors choosing family medicine?
Dr. Glenn Dregansky, president of the Michigan Academy of Family Physicians and a primary care doctor in Jackson County, said the reasons are complex, but among them is pay.
“Family docs, we are right down there with the pediatricians as the lowest reimbursed specialty in America,” he said.
“I had students that I would rotate in our department and I'd say, ‘You’re really sharp. You should think about family medicine.’ I had a third-year medical student look at me say, ‘You guys work way too hard and you don't get paid diddly.’ That's one of the things we face.”
Does it affect the entire state?
Yes, but the problem is worse in some parts of Michigan than in others.
“The supply of family doctors and other primary care professionals is not evenly distributed throughout the state,” Phillips said. “Fifty-eight of Michigan's 83 counties are rural and many of those rural counties are Health Professional Shortage Areas.”
“In rural communities, the primary care shortage is compounded by the closure of rural hospitals and limited access to obstetric care, including labor and delivery care. ... Family doctors provide preventive care to adults but they also provide preventive care to children and obstetric care. ... In a lot of our rural communities, family physicians are the only physicians who are delivering babies."
What’s being done to solve the problem?
"One of the most critical things we can do is try to retain people who train here and keep them from leaving because we do graduate family physicians every year from residency programs," Phillips said.
Michigan has two primary care workforce programs aimed at recruiting, retaining and diversifying primary care physicians, especially in underserved areas.
The first is MIDOCs, a state-funded program that offers up to $75,000 in student loan repayment to medical residents from Central Michigan University, Michigan State University, Wayne State University and Western Michigan University who choose residencies in primary care and other high-need specialties and agree to work at least two years in underserved areas in the state.
The second is the Michigan State Loan Repayment Program, which offers up to $300,000 to repay student loans if physicians agree to work for two consecutive years at eligible nonprofit sites providing primary health care. The program is funded by federal, state and local governments.
"That loan repayment program is probably the biggest piece in rural Michigan that we've been able to help retain physicians with," said Dr. Ross Ramsey, president and CEO of Scheuer Health, a small, independent hospital in Pigeon, in the Thumb.
Dregansky added: "It takes time to train physicians. Yes, we have a shortage. Yes, we've been talking about the impending shortage for years, now, in organized medicine. … That’s why MIDocs was developed. That's why we've supported the student loan repayment program to try to address this this worsening shortage. There aren't any really short-term solutions for getting more family docs, necessarily. There are some things that are going on."
Among them, he said, is work he's doing on a task force that is examining whether the number of primary care physicians can be boosted by foreign-trained doctors.
Contact Kristen Shamus: email@example.com. Follow her on Twitter @kristenshamus. Subscribe to the Free Press.
This article originally appeared on Detroit Free Press: Michigan has a shortage of primary care doctors. What's being done?