ST. LOUIS — The University of Missouri is one of five institutions nationwide to receive nearly $5 million in federal funds to address the looming shortage of primary care physicians, considered key in addressing the state’s poor health outcomes and aging population.
The $5 million is the largest award for rural medicine in the school’s history.
The nation faces a shortage of up to 49,000 primary care doctors in the next 10 years, according to a report released last year by the Missouri Hospital Association. The trend is expected to leave large primary care “deserts” in rural areas and underserved portions of urban Missouri.
A federal analysis predicts Missouri will have a shortage of 1,220 primary care providers by 2025.
Eight acute hospitals in rural Missouri have also closed in the past five years, leaving 44 counties without a hospital, according to the report.
“When a hospital closes, most of the time the health care system in that area is significantly harmed,” said association spokesman Dave Dillon, because the hospital’s system of clinics and referring physicians tend to leave too.
At the same time Missouri is facing a growing shortage of doctors, the state ranks 39th nationally in a collection of numerous health measures, worsening from 37th place five years ago, according to the United Health Foundation.
Most of the $5 million in federal grants, awarded by the Health Resources and Services Administration, will go toward the expansion of programs already in the works to recruit college students from the rural areas they care about to pursue rural medicine; while also exposing more medical school students to doctors in small-town clinics instead of specialists at large teaching hospitals.
“We already have several unique programs designed to offer our medical school student encounters and training in rural and underserved areas, and this grant will enhance those initiatives in new and innovative ways,” said Dr. Steven Zweig, interim dean at the University of Missouri School of Medicine in Columbia.
Primary care physicians — which include family doctors, pediatricians and internists — are the backbone of the health system. They ensure individuals get the care they need, manage chronic conditions and prevent disease.
The need for primary care physicians is being fueled by an aging workforce as well as aging baby boomers. In 2030, older people are projected to outnumber children for the first time. In Missouri in 2030, more than one-fifth of its residents will be over age 65 — a projected increase of 87% since 2000.
The problem is more acute in rural areas, where residents tend to be older and have higher rates of chronic diseases than their urban counterparts. While there are about 60 primary care providers for every 100,000 rural residents in Missouri, there are 139 per 100,000 urban residents.
The federal money will be used to increase support for rural hospitals serving as training locations by covering the costs of hosting and mentoring medical students, officials say.
Money will also be used to create programs to teach hospital staff how to best recruit and retain providers.
“This grant will make it possible for rural doctors to bring the students in and not only teach them, but also talk with them about rural medicine and the resources available in a rural community,” said Kathleen Quinn, the university’s associate dean for rural health. “The physicians and students will have time for more meaningful interactions thanks to this grant.”
A smaller portion of the money — $750,000 — will fund the development of a new family medicine residency program at the Bothwell Regional Health Center in Sedalia.
After graduating medical school, doctors complete a multiyear residency in their field of medicine. Creating more rural residency slots in primary care fields is considered key in helping the state retain doctors in shortage areas.
Studies show that about 68% of doctors end up staying in the state where they complete their training. Yet in Missouri, the small number of residency slots restricts the pipeline.
Only 21.5% of the state’s medical school graduates remain in Missouri because the number of residency slots has not kept pace with a 10% increase in medical school enrollment since 2006, according the hospital association report.
Across the state, hospitals and community clinics offer about 350 residency positions in family medicine, pediatrics and internal medicine; and most of those are in urban areas like St. Louis, Kansas City, Columbia and Springfield.
While the new residency program in Sedalia will start with just two positions, officials said they hope it will lead to more funding toward resident programs at other rural hospitals, which typically can’t afford creating and hosting a program.
“Innovation will be key,” Dillon said. “We will have to look at this program and those like it and decide what works best and replicate it.”
To encourage more primary care providers in shortage areas in the city, St. Louis University School of Medicine started a family medicine residency program eight years ago at a community health center serving those on Medicaid or with no insurance in the Carondelet neighborhood.
Graduating six family physicians a year, it’s the only family medicine residency program in the city.
The school created the program to inspire resident physicians to continue working in poor urban or rural areas, which about half of them do, said Dr. Fred Rottnek, the medical school’s director of family and community medicine. The results are good, he said, and will only improve as the program builds its reputation.
Rottnek said, “We really need additional support at the federal level to increase the number of training spots for residents.”