HJNO Mar/Apr 2024

PHYSICIAN ACCESS GAPS 32 MAR / APR 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS   we were able to allocate between $7 million and $10 million towards a rural physician primary care tuition reimbursement fund.” Under that program, physicians can receive up to $180,000 for loan forgive- ness. St. James Parish Hospital CEO Mary Ellen Pratt said this investment has helped her independent rural hospital recruit doc- tors, adding, “for the ones who need it, it’s a lot of money to them, and it makes a huge difference.”She also mentioned LSU’s Rural Scholars Track (RST) as a helpful recruit- ment tool. “Students receive a full tuition waiver (four years) if they agree to go into pri- mary care practice in rural Louisiana for five years after completing their residency,” said DiCarlo. “This RST program has put 70 doctors out in practice in Louisiana. That is one of the more successful such programs in the country.” Last year, Rep. Echols also passed a legis- lative resolution that urged LDH to measure physician supply by location and specialty throughout the state and to report on the capacity of and geographic distribution of Louisiana’s GME programs. According to the U.S. Department of Health & Human Services (HHS), “only two percent of resi- dency [GME] training occurs in rural areas and training physicians in rural areas increases the likelihood of practicing in a rural community.” In his previous career in the healthcare industry, Rep. Echols partnered with Uni- versity of Louisiana at Monroe (ULM) to study ways to increase the supply of rural primary care physicians in northeast Loui- siana. He said those conversations played a role in encouraging the Edward Via College of Osteopathic Medicine (VCOM) to open a new Monroe campus in 2020. VCOM-Louisiana “The intention and mission of the school was to produce graduates who would stay in primary care,”said VCOMVice Provost of physicians evenmore important. TheAAMC found that nearly one third of Louisiana’s physician workforce is age 60 or older. The American Medical Association recently warned that “though the number of medical students continues to grow, resi- dency [GME] training has not kept pace with the expanding, aging population and their complex health needs.” Gov. Jeff Landry’s transition team recently recommended tak- ing “a comprehensive look at how to gradu- ate and retain more physicians, while also expanding options for residency and fellow- ship programs.” “I know we have a lot of students who are looking for residency slots,” said Och- sner Lafayette General Chief Medical Offi- cer Amanda Logue, MD. “If you don’t have any place to train them, they’re going to find somewhere else to go, and they’re going to stay where they do their training for the most part.” “We want medical students to train in Louisiana, we want them to live in Louisi- ana, and we want them to practice in Louisi- ana,”added Louisiana Department of Health (LDH) Secretary Ralph Abraham, MD. Furthermore, federal studies predict a nationwide physician shortage of as many as 139,940 physicians by 2036, warning that a need for doctors in family medicine, gen- eral internal medicine, pediatrics, and geri- atrics, “will make it especially difficult for Americans in nonmetro areas to find the care they deserve.” With these challenges and opportunities in mind, state lawmakers and healthcare leaders are collaborating to improve the training and retention of Louisiana’s phy- sician workforce. Loan Forgiveness, Scholarships, and LDH Studies “Primary care for me is the number one target that we need to be focusing on and growing,” said Rep. Michael Echols (R-Monroe). “Just a couple of years ago, Can Louisiana prevent a physician short- age that weakens the health of our state? Last year, Louisiana State Board of Medi- cal Examiners Executive Director Vincent Culotta, MD, began a presentation by high- lighting a study predicting Louisiana could experience the third worst physician short- age ratio in the nation by 2030. While this study had limitations, experts warn that Louisiana has an uneven distribution of physicians by specialty and geography, with rural and underserved communities strug- gling to recruit and retain physicians. “I think primary care is traditionally an area where we have a shortage, and rural primary care is definitely an area where there has always been a shortage,”said LSU Health New Orleans School of Medicine Interim Dean Richard DiCarlo, MD. According to the federal government, nearly 2.6 million Louisianians live in a primary care health professional shortage area (HPSA). Research funded by the Rob- ert Wood Johnson Foundation found one Louisiana parish with a ratio of one primary care physician per 22,000 people compared to a national average ratio of one primary care physician per 1,310 people. A2019 study found “people live longer in areas withmore primary care doctors.” While Louisiana ranks fifth per capita among other states in the number of stu- dents who graduate from in-state medical schools, theAssociation of American Medi- cal Colleges (AAMC) reports that more than 60% of all Louisiana medical school gradu- ates leave to complete their Graduate Medi- cal Education (GME) training outside the state. Unfortunately, Louisiana loses return on investment when so many of these new physicians permanently leave the state. In contrast, AAMC reports that Louisiana retained more than 70% of individuals who completed both medical school and GME in the state. Louisiana’s aging physician workforce makes the training and retention of new