Obama hopes to fund doctors to work in primary care for rural areas

Doctors across the nation are trading primary care for specialized fields that pay more, leaving rural and underserved communities with a shortage of primary care providers — a gap that President Barack Obama aims to fill.

Obama’s 2015 budget proposal includes $5.23 billion designated to produce 13,000 doctors in the next decade for high-need specialties such as primary care.

The budget also aims to expand the National Health Service Corps, a program that places primary care physicians in underserved rural and urban areas, from 8,900 to 15,000 providers between 2015 and 2020.

“The president’s budget proposes a sustained level of commitment to the NHSC through 2020 totaling $3.95 billion,” said Samantha Miller, spokeswoman for the NHSC, in an email.

More than one-fifth of Americans live in primary care shortage areas, Miller said.

Dr. Evan Ashkin, a professor at the UNC School of Medicine, said medical students are being discouraged from going into family medicine because of the pay disadvantage compared to specialized practitioners.

“If you choose a primary care specialty, you’re leaving about $3.5 million on the table in lifetime earnings,” he said.

He said North Carolina is also suffering a shortage of primary care doctors.

“There was a study done by the N.C. Institute of Medicine and they think we’re probably shy in this state by about 2,500 to 2,700 (family doctors),” Ashkin said.

He said in cities like Boston and San Francisco, where he trained, some doctors looked down on primary care practitioners and said they weren’t fulfilling their potential — but the community members they served disagreed.

“UNC is definitely trying to reach out and find medical students who are planning on doing primary care and will work in rural areas,” Ashkin said.

He said the medical school admissions committee is aware of the primary care shortage and tries to recruit applicants from rural North Carolina, because those are the ones most likely to go back and work in an underserved primary care setting.

Eli Tiller, a fourth year UNC medical student from Boone, said he chose to pursue family medicine because there are no limits to the people you can treat.

“I worked at an open-door clinic in Raleigh that served underserved populations, and I was inspired by this clinic,” he said.

UNC caps the number of family medicine residents it can train, Ashkin said — a limit he said should be overturned to alleviate the shortage.

Specialized residency positions at UNC turning into family medicine slots would also help combat the shortage, Ashkin said.

Tiller said although specialized practitioners are important, family doctors can provide a more holistic approach to treating patients and can adapt to a population’s particular needs.

When people have health issues, they need to be able to call a doctor with a wide range of skills, rather than one with a more narrow specialty, he said.

“Family doctors are medical handymen.”

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