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Monday, December 09, 2019

With Funding For Training Set To Expire, Rural Doctor Shortage Persists

By Rob Hotakainen, McClatchy Washington Bureau

WASHINGTON — After two years as a medical school resident for the Puyallup Tribe of Indians, Aaron Rhyner sees 14 patients a day, works 50 to 80 hours a week, and earns roughly $50,000 a year.

Rhyner, 29, of Tacoma, Wash., calls his work “something special,” a chance to make a difference. He’s also doing his part to help fix a growing national shortage of primary-care physicians, which is expected to approach 52,000 by 2025, hitting rural regions and Indian reservations the hardest.

Experts say the national shortage is fueled by more doctor retirements, an aging and more rapidly growing population, and more people having health insurance. Many worry that if the government doesn’t intervene, too many low-income Americans will be locked out of the U.S. health-care system.

“If you call up and you can’t get an appointment because there aren’t any primary-care physicians, you’re not getting access to health care,” Democratic Sen. Patty Murray of Washington state said in an interview.

Rhyner owes his job to Congress, which four years ago included $230 million in the Affordable Care Act to pay for training 550 graduate residents in 24 states.

With that funding set to expire next year, Murray wants Congress to spend $495 million more to keep the training going until 2019.

Murray, the head of the Senate Budget Committee and a veteran Senate appropriator, said her home state is expected to be nearly 1,700 doctors short by 2030.

She called the Puyallup tribe in western Washington state “a prime example” of a community that needs government help.

When the tribe created its residency program for medical school graduates three years ago, it had only two medical residents, including Rhyner.

This year the tribe is training 10 doctors, using $1.5 million in federal grant money. Its facility opened as the first osteopathic family medicine residency in the country with a Native American focus. Now there are two, with Oklahoma’s Choctaw Nation running a similar program. In Washington state, federal officials this year also paid for training programs in Yakima, Spokane, and Toppenish.

Nationwide, 60 graduate programs are operating in two dozen states this year, including California, Florida, Idaho, Illinois, Kentucky, Mississippi, Missouri, North Carolina, Pennsylvania, and Texas.

Rhyner said most of his medical school classmates at Pacific Northwest University wanted to work in specialty fields that pay more, but he wanted to focus on family medicine and “get a chance to do everything.”

He grew up in Alaska but traveled extensively. He said he liked the idea of working on a reservation and joining a startup residency program he could help shape.

“I have kind of an eclectic background in the sense that my mom is from Pakistan and my dad is from Minnesota,” Rhyner said. “So I’ve lived all over the world. … I’ve experienced Third World countries and areas where they don’t have an opportunity to get access to good health care. It makes such a huge difference when we are there and we can help them.”

When he came to the reservation, Rhyner said, he wanted to “experience the community.” He has done just that, attending powwows, and participating in sweat-lodge ceremonies.

While the Affordable Care Act that expanded health-care coverage has become a political target for many Republicans, ridiculed by many critics as “Obamacare,” Murray said the teaching program deserves to be extended.

“Look, this was part of the bill that has turned out very successful,” she said. “We are expanding on that.”

On July 31, Murray introduced a bill — the Community-Based Medical Education Act of 2014 — to keep the program running at its current level through 2019. At that point, her bill would establish permanent funding under Medicare to train primary-care physicians in community-based settings, creating 1,500 more residency slots nationwide.

Murray has her work cut out for her, even though no opposition has emerged. She introduced her bill right before Congress left Washington for its long summer recess. So far, she has yet to line up any co-sponsors, and no similar legislation has been introduced in the Republican-led House.

Photo: Joe Shlabotnik via Flickr

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