http://www.dailyworld.com/html/DD85E...6107032A.shtml


State fighting to get doctors in rural areas
Forty of Louisiana''s 64 parishes have a serious shortage of health clinicians
Louisiana Gannett News
Posted on September 26, 2004
Ending his three-year residency training in family practice at a clinic in rural North Caddo Parish, Dr. Greg Salard, 43, knows where he is going to spend the rest of his life.

"I like practicing in a rural area because you get to do a lot of everything. I used to say a 'little of everything,' but it's a lot of everything," Salard said. "I have already decided to stay in Vivian at the clinic. I've signed the contract."

Salard fits the profile of a medical student more likely to be willing to go to a rural area to establish a practice: he grew up in the Natchitoches area. After an Air Force career that took him all kinds of places, including an Alaskan island, he returned to the Shreveport medical school.

His choice to remain in Vivian, where LSU-HSC operates a small family practice residency program, is not uncommon: data shows that doctors tend to land within 75 miles of wherever they received their residency training, according to state research.

More parishes in Louisiana are facing shortages of health care clinicians than have enough: 40 of Louisiana's 64 parishes have a serious shortage of health clinicians; 20 have been identified as having critical shortages of doctors. And it's not just rural areas: New Orleans is the one urban parish that is seriously medically underserved.

To do something about it, the state has a multi-pronged attack that includes family practice residency programs, such as those in Vivian, Monroe and Alexandria, and offers cash incentives to doctors.

The state dangles money in front of residents, who face an average of $150,000 in student loans by the time they finish their third year of residency.

There are two financial programs in place:

n The state, with equal funding from the federal government, provides a loan payback for all clinicians (doctors, nurse-practioners, physician assistants or dentist) that will pay $30,000 a year for up to three years for those who remain in a rural area.

"The theory is that physicians with an enormous amount of debt after their residency will become entrenched in that community," said Kristy Nichols, director of the Bureau of Primary Care and Rural Health.

n In addition, the National Health Service Corps has a loan repayment program paying up to $150,000 if the clinician stays in the community for five years.

"If you coupled that with the state program, you could have loan repayment for up to seven years and $200,000," Nichols said.

Part of her mission, Nichols said, is to make sure that undergraduate students know about the loan payback programs even before they get to their medical training.

Using those loan programs, the state induced 18 doctors to locate in rural communities this past year, which could help alleviate the shortage.

"If you have been practicing in a rural community for seven years, you are less likely to leave," Nichols said.

In addition, the state has hired a recruiter to travel not only to Louisiana medical education centers but also to schools in surrounding states to recruit doctors to towns that could not afford to pay for their own private recruiter. In the 18 months since the program began, 20 primary care physicians have been recruited for underserved areas in Louisiana.

Over the past year, the state has conducted extensive research of medical students, seeking solutions.

"What we are finding is the biggest impact we could have in the future is in medical student admissions selections," Nichols said.

"There are certain predictors about how likely you are to practice in a rural area, the No. 1 predictor being that you are from a rural area," Nichols said. It's the bureau's goal to get the medical schools to integrate those predictors into their selections process.

Expanding family medical residency programs is a very effective tool.

"Family physicians are overwhelmingly more likely to practice primary care in a rural area than other primary care specialists," Nichols said.

Dr. John McDonald, chancellor of the LSU-HSC-Shreveport, said med schools are trying to identify potential doctors in rural communities while they are still in high school. In addition, the medical school's training program is being re-arranged so medical school students spend more time with family practice doctors.

"We want them to learn first-hand what these doctors do every day," McDonald said.

"The idea is to reinforce the good things about family practices in small towns," McDonald said, "and do it while they are students and making up their minds what residency they will train in."

When doctors do go into family practice residency training, the LSU data shows they are more like to stay within the region where they do the training, urban and rural.

Of the 164 graduates from the family practice residency program at the Shreveport medical school since it was established in 1974, 111 ended up in urban settings, and only 53 in rural areas. The program has provided Shreveport with 53 family doctors, Bossier with nine, Monroe-West Monroe with seven, Lafayette with five and the Pineville-Alexandria area with four, but doctors from the program have also ended up in Bernice, Bunkie, Carencro, Crowley, Delhi, Haughton, Heflin, Homer, Opelousas, Ruston, Simsboro, Winnfield and Winnsboro.

The family practice residency program established in Alexandria in 1995 was, by percentage, more successful in providing rural doctors: Of the 25 graduates, 12 have ended up in rural areas, including such towns as Jonesville, Winnfield, Bentley and Marksville.

A Monroe family practice residency program set up in 1981 produced 96 graduates, but the locations of only 77 are known, and of those 47 stayed in urban areas and 30 in rural areas. The data shows many doctors ended up in Northeast Louisiana.

Of the known Monroe residency graduates, 27 stayed in Monroe, two went to Rayville, two to Eros, three to West Monroe, two to Natchitoches and others wound up in Bastrop, Delhi, Homer, Jonesboro, Mer Rouge, Ruston and Swartz.

The newest family practice residency program was the 1997 program set up at the Vivian clinic. Of the seven graduates, five ended up in rural areas, as Dr. Salard will next year.

Besides establishing residency programs with training in rural areas, the state participates in a federal program of placing foreign doctors in rural areas. Run in cooperation with the U.S. Immigration and Naturalization Service, the program offers green cards granting these foreign citizens the right to remain permanently in the United States.

"We have up to 30 slots, but have typically placed about 20 foreign doctors a year," Nichols said. "The issue is after they get the green card, they leave for other areas."

A new program of providing free medical school training to 15 new Louisiana high school graduates a year, expanded from four, for those doctors who would spend five years in a rural area was authorized in a bill authored by Rep. ******* Thompson, D-Delhi, during this past session. But it was not funded.

Dr. McDonald said he and Thompson would seek funding for the free medical education program next year. As tuition, room and board at the LSU-HSC medical schools in Shreveport and New Orleans runs about $30,000 a year, this is a considerable incentive. (Doctors who brought their commitments would have to pay back double.)

"That funding would help," McDonald said.

Getting doctors into rural areas is a tough battle, as some 84 percent of medical school students told state researchers they would prefer an urban setting.

"It is a very complex problem," McDonald said. "We are making an effort."

__________________
Moderator - State Licensing Forum

Still skeptical after all these years.
This is it. There are no hidden meanings.WYSIWYG

http://www.internetmedicalschool.homestead.com

http://www.chiropractormds.homestead.com/index.html

sounds good to me....

__________________
Saba Forum Moderator
Saba University School of Medicine, MSIV
Interests: Pediatrics, Psychiatry

Ok; you want to know the REAL reason? The comments in that post or soo full of it.

Being a native Sheveporter I just want to rant my opinion. The reason for the shortage is that the med center here gets alot of it's students from out of state. Once they graduate, they leave. It's that simple. It's a state learning facility with one of it's goals to supply the state with doctors. They are failing at this imo.

My question to them is:
Is it better to accept a person from Florida that has a 4.0/30 MCAT that will leave after graduation or maybe even after a residence or accept a local person with a 3.45/27 MCAT that wants to practice in a rural community in Louisiana?

I know the answer after trying to apply for 5 years in a row. Heck, they will not even talk to people that want to apply. After knowing a personal friend that got in because of "who you know" I threw my hands up at the place.

Louisiana has a long way to go. I doubt I will come back. If I sound a tad recentful; I am.

JD

I agree with you on what you say. Why residencies don't factor in how mahy of the students will stay in the community afterwards amazes me too. A waste of taxpayers money.

__________________
Moderator - State Licensing Forum

Still skeptical after all these years.
This is it. There are no hidden meanings.WYSIWYG

http://www.internetmedicalschool.homestead.com

http://www.chiropractormds.homestead.com/index.html

As far as the Chancellor is concerned the numbers are more important. The federal money/grants coming in stems from how the school and research center look on paper. If you have to keep your numbers up by letting in more out-of-state people then so be it. It prevents the DIRECT "finger pointing" to the school because it ranks low nationally and money is being cut or redirected. This has happened several times btw.

The long term affects are the shortage of MDs in the state but at least the school has good numbers and the money is coming in for research, expansion, ect..
As far as the school is concerned; their major money doesn't come from the graduation of MDs so why should they care where they go? Of course nobody is going to say this. This is the hard true and just my opinion.

JD

I too am from Louisiana, and after receiving my rejection email, and after having the dean write following in the email, I decided to go Caribbean.


"The first thing to do when facing the reality of reapplying is (pick one):

a. Call for an appointment with the Dean.

b. Get an application for a school in the Caribbean.

c. Resubmit as soon as possible.

d. Think about things.

(Correct answer is d.)"

I've lived here all of my life, and the longer I'm here, the more I'm seeing that it's not how qualified you are for a position but rather who you know. I didn't know that LSUS took out of state applicants. I guess that's just me being naive, but on the application, it said they would only take out of state alumni. I want to come back here to practice, since all of my family is over here. Does anyone know how to get more information on the rural program?

I am not too sure about your comment of taking a large percentage of outta state students.

As i understand it LSU is mandated by the state legislature to talk only LA residents for its two medical programs. Tulane is allowed to take who ever they want cause they are privatly funded.

The MSAR for last year also listed all entrantants to LSU-S as residents. If the situation is that a LA born and raised kid went to school in FL and then got accepted to LSU i see no problem with that.

I would like to see the site or sourse that you got thoes numbers from, i am not trying to call you out or anything, but the information that i have is very different.

As for low numbers of DOCs in LA, keep in mind that somewhere in the area of 40 to 50 percent of LSU med graduates are female and a large number of thoes ladies only pratice for a few years untill they start having kids, the same is happing whit the profession of pharmacy, most of the Female docs and pharmacists only pratice part time or not at all.

Later,
YODA
GEAUX TIGERS

Ouch. That is a totally inappropriate thing for a dean to tell a prospective student. Good luck getting your MD anyway!

__________________
Saba Forum Moderator
Saba University School of Medicine, MSIV
Interests: Pediatrics, Psychiatry

Are there any programs for Podiatrist in that state to come and practise? because podiatrist have the same amount of student debt.
Steve

I will add to this list of rejected LA med school applicants and I will also confirm this letter by the dean. I currently attend AUC, first semester, and am 100% sure that this path was the better one taken. After explaining to this dean that I fully intended on staying in LA and practicing in a rural area, it did nothing to sway their opinion (I have a 3.7 GPA with a masters degree in Physiology). Somehow, if your father knew people on the admissions board, this magically worked to change that opinion for students with lower GPA's and lower MCAT than myself. When I came to AUC, people accused LA of putting up billboards for AUC because there are so many LA students here. I quickly explained, go talk to the dean or anyone in charge of admissions in a LA med school (there are two) and you'll quickly realize why so many of us choose this route.

Last year's class only kept less than half of their graduates in state. LA can definitely do better than that.