In Mo., doctors in short supply in rural areas

COLUMBIA, Mo. -- Gravel roads, small towns and rows of corn that go on for miles -- these are images of rural Missouri.

More often than not, doctors are missing from that picture.

Eighty percent of Missouri's counties don't have enough physicians. Many of those counties are rural, according to the Missouri Department of Health and Senior Services.

One of the ways MU's School of Medicine has sought to draw more physicians to rural areas is through the Rural Track Pipeline Program. It began in 1995 and continues to educate medical students about the importance of practicing in rural areas.

A big factor in the shortage of health care providers is the retirement of baby boomers, said David Oliver, assistant director of the MU Interdisciplinary Center on Aging.

Approximately 78 million people born between 1946 and 1964 make up the baby boom population. In 2011, the first baby boomer will turn 65 years old.

More rural seniors

According to the Office of Social and Economic Data Analysis, the population of people age 65 to 74 has increased in many rural counties in Missouri. Webster County, just east of Springfield, grew 15.3 percent between 2000 and 2004 in people ages 65 to 74. The current population of Webster County is just over 36,000.

That means that over the next 20 years, there will be an extreme need for physicians, especially in rural areas, to better serve the aging population.

"The impact will be dramatic," Oliver said. "Our health care system is not prepared."

Despite cuts to the Missouri Area Health Education Center budget, which assists the Rural Track Pipeline Program, it continues to give medical students firsthand experience in rural medicine by sending them to rural areas to live and learn.

"The goal of our program is to address the maldistribution of physicians in Missouri by getting more physicians to understand health access and disparity issues by rural training," said Kathleen Quinn, program director of MU Area Health Education Center.

Quinn sees success in the numbers: More students in the program enter primary care residencies in Missouri than out of state, and 28 percent of them go on to practice in towns of 50,000 or less, she said.

Nationally, only about 10 percent of physicians practice in rural areas, according to National Rural Health Association.

"The pipeline is renewing in the sense that we have students who were part of the program in the mid-'90s that now teach students participating in the Rural Track Pipeline Program," Quinn said.

Karlynn Sievers, 36, graduated from MU's School of Medicine in 2001 and was a student in the program during its first few years. She now teaches medical students in the program.

For four years, Sievers has taught in Rolla -- a town of about 18,000 -- the importance of practicing in rural areas.

"I think it's really important to give students a feel of what a rural area is like," Sievers said.

In her view, the program also gives students more experience than studying in a larger city would do.

Sievers knows of the shortage in rural areas and said that is the most important thing she teaches them.

"We need docs," Sievers said. "There's just a huge demand."

The problem will just escalate if the final health care reform bill includes a public option, Sievers said.

"We have this huge uninsured population that doesn't have access to the services they need right now," she said. "If we suddenly insure these people, and they can get access to the health care they need, we're going to need so much more manpower."

In St. John's Clinic, where Sievers works as a family physician, a receptionist greets every patient. Within minutes, one of the five doctors in the practice appears and welcomes the patient to an examination room.

Although Sievers sees about 25 patients a day, she said she's on a first-name basis with all of her patients. The babies she has delivered since she arrived in Rolla five years ago have grown into toddlers, and she does their annual checkups.

Sievers, who did her residency in Kansas City, said it's harder to develop such a bond with patients when working in a larger city where there are so many doctors and specialists. For example, if a patient came to a family physician in a large city with a heart problem, he or she would be sent to a cardiologist. In a smaller town, the patient might remain with the family physician, depending upon the problem.

Sievers knows her patients so well that she anticipates spending extra time in the grocery store because she knows she'll bump into patients and wind up having 12 conversations.

"I shop at Country Mart to get groceries, and I swear every one of my patients shops at Country Mart," she said. "I thought it would be an awkward thing, but it's not. It's kind of a neat experience.

"You get to feel like you're a piece of the community," she said. "I think a lot of why we go into medicine is because you want to feel like you're making a difference for people and you want to feel like you're helping their lives. And when you're in a big city, you may not ever really get feedback about that."

"But when you're in a small community, you see these people and you think, 'Wow, look at all these people I know I got to take care of."'