Family Physicians Seek $6 Million for Loan Repayment

August 11, 2010 -- It’s not news that Oregon faces a shortage of primary care physicians, particularly in rural areas. Recruiting new physicians to family care -- frequently with longer hours and lower pay than other specialties -- has always been a challenge, but is even more difficult in a less than stellar economic climate.

 

The Oregon Academy of Family Physicians (OAFP) hopes to close the financial gap for recruitment and retention of primary care physicians with legislation to be introduced in 2011.

 

House Bill 3639, which was passed earlier this spring, transferred Oregon’s loan repayment program for physicians -- an incentive for new doctors to choose primary care -- to the Office of Rural Health at Oregon Health & Science University. It also zeroed out the program’s $400,000 in funding.

 

“We were super happy to see that it was relocated,” says Kerry Gonzales, executive director of  the OAFP. “But they didn’t give it any funding.”

 

In comparison, OAFP says Washington funds its rural healthcare loan repayment program at $8.7 million per biennium.

 

Doug Barber, the lobbyist representing OAFP, says rural clinics in Oregon are going up against similar facilities in Washington to recruit physicians, but they can’t compete when it comes to loan repayment.

 

The OAFP package to be presented in Salem by Rep. Chris Harker (D-Washington County) asks for $6 million per biennium for loan repayment for eight physicians, five dentists, five nurse practitioners and five physician assistants each year.

 

OAFP’s legislative package includes other recruitment incentives -- like graduate medical education, an increased number of family medicine residency slots in Oregon and loan forgiveness for medical students who agree to practice in rural Oregon after graduation -- incentives to retain rural primary care physicians and measures to address payment reform.

 

OAFP is confident the legislation will pass.

 

“We really haven’t had any opposition to it,” says Gonzales. “All the tweaks that people have suggested make good sense to us. We’ve been happy to do it.

 

But in a tense economy, the question of money remains.

 

Barber says OAFP is hoping for $1 million for the coming biennium to help get recruitment, retention and reform measures off the ground.

 

“I don’t even know if that will be on the table, or if it will just be in discussion at this point,” he says.

 

“Everybody we talk to says, ‘Let’s start the conversation with, There is no money,’” says Gonzales. “What we’re trying to do with this package is to leverage anything that’s coming from federal health reform, and trying to look to the future and doing what little bit we can do now.”

 

In the meantime, many new doctors finish school with $150,000 or more in loans.

 

“If you’re asking somebody to go into family medicine and then to practice in a rural area, and they start looking at lifetime earnings and all those projections, it’s much lower than it would be in other specialties, and it’s much lower than it would be in other locations,” Barber says.

 

Without loan repayment as a recruitment tool, he says, “rural areas have an uphill battle trying to find physicians who are willing to practice in areas where they have to be on call much of the time and do it for less money.”

 

“To some extent, sometimes primary care is the Rodney Dangerfield of medicine,” laughs Dr. Elizabeth Steiner, OAFP President-Elect. “We need to make primary care a more attractive specialty.”

 

OAFP’s proposed solutions are decidedly long-term. Gonzales admits there are few immediate fixes to Oregon’s looming primary care physician shortage.

 

Steiner says things will only get worse when federal healthcare reform goes into effect. More people will have insurance, but there still won’t be enough doctors. But Oregon’s rural loan repayment program has historically had more applicants for available slots than funds to provide for them.

 

“We know that the people who are most likely to go into practice in rural areas are those that come from rural areas or those who spent a lot of time in rural areas when they’re in training,” she says. “So adequate funding for a loan repayment program for rural primary care physicians would be enormously helpful..”

 

 

For more about the legislation being proposed by the Oregon Academy of Family Physicians click here.