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Michigan's shortage in primary care doctors

Sep 10, 2015

The battles over the Affordable Care Act – Obamacare, if you are a Republican – have been bitterly fought, and at least for the time being, won. The President’s main goal was to make health insurance and health care available to more people, and he’s done that.

There’s still a problem, however. Even if you have coverage, it’s hard to get health care without a doctor – especially what’s known as a primary care physician. Specialists are thick on the ground, especially in affluent areas, like Birmingham or Ann Arbor.

But you are going to need a lot of luck if you have to try finding a general practitioner, pediatrician or psychiatrist in rural northern Michigan, or the city of Detroit itself. If you have small children, you’re probably better off medically if you live in Oakland or Washtenaw counties.

They have ten times as many pediatricians as the medical profession considers ideal for the size of the population. But if you have kids and are thinking about taking a job in the far-off Keweenaw Peninsula … good luck.

Those statistics come from a report published this summer by the Citizens Research Council of Michigan, which has been doing important, non-partisan research and policy analysis for nearly a century. 

They conducted a comprehensive study of medical care, and found that Michigan has an overall shortage of primary care providers, one that’s likely to get worse.

This is something I had been hearing about anecdotally for years from doctors, or people who’ve been looking for a primary care provider. The CRC report provides solid evidence that that’s the case.

And while there is a shortage, the problem is even more one of distribution. Pleasant, relatively rich areas are well-served, poor areas not.

This not only sounds unfair; it has social consequences; areas with more primary care doctors have lower mortality rates. There are a number of reasons for this; doctors, like everyone else, prefer living in nicer places. But specialists also tend to be paid more, and the average medical school graduate emerges with something like $150,00o dollars in debt.

Eric Lupher, the president of Citizens Research Council, wrote a column last weekend in which he outlined a number of policy initiatives our leaders could take, including loan forgiveness for primary care physicians and changing Medicaid reimbursement rates and other provider payment systems in a way more favorable to primary care physicians.

Trouble is, Michigan has a legislature that cannot even manage simple road repair, and whose members regard any kind of government spending as anathema. Battle Creek’s Joe Schwarz, who’s both a politician and a practicing physician, has a simpler plan that I think makes a lot of sense. He’d have the state spend about $12 million a year for scholarships for 40 to 50 students willing to go into primary care.

They would get a free medical education in return for making a commitment to practice for at least eight years in an area in Michigan where the need exists. Schwarz thinks we’d be getting a bargain. When you think of what we spend on prisons, the cost would be insignificant. Nothing is more important than the future health of our citizens. Now all we need is the political will to get it done.

Jack Lessenberry is Michigan Radio's political analyst. Views expressed in his essays are his own and do not necessarily reflect those of Michigan Radio, its management or the station licensee, The University of Michigan.