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Study: Tennessee experiencing shortage of primary care physicians

Zach Vance • Updated Mar 5, 2016 at 7:26 PM

Nearly one in five Tennesseans live without adequate access to primary health care.

A recent study from Avalere Health found 18 percent of people in 111 different areas around the Volunteer state do not have access to enough doctors.

It isn’t just a Tennessee problem: the shortage affects the entire country. Nationwide, approximately 57 million Americans do not have proper access to primary care physicians, the study found.

With an increasing population in need of primary care, including the baby boomer generation, research showed the nation will experience a deficit of nearly 52,000 doctors by 2025.

The study classified a physician shortage as an area with 3,500 or more people per primary care physician.

Dr. John Franko, chair of East Tennessee State University’s Department of Family Medicine, said there are no easy answers to  the inadequate supply of doctors in his field. 

“The strategy will take national action,” Franko said.

Franko said the shortfall is a result of insufficient funding for physician residency programs. In every state, a student who finishes medical school has to complete all or part of what’s called a residency program before getting a medical license and becoming a doctor.

“So the issue is that the federal funding for residency (programs) has been static since 1996,” Frank said. “What needs to happen is decisions need to be made at the national level on how to create additional funding for residency positions so that we can increase the number of residents who go through the training. Then we will have more physicians available through the country.”

Data collected by the Association of American Medical Colleges shows Tennessee had the greatest discrepancy between medical school graduates and residency programs in 2014. Of the 740 Tennessee medical students who graduated that year, only 540 residency slots were available in the state — meaning 200 graduates went elsewhere to finish their training. 

A recent study by the Tennessee Rural Partnership looked at the total number of primary care physicians in each county of East Tennessee. 

The study found Johnson County has only nine primary care physicians and Unicoi County seven. Eight other counties in East Tennessee also have 10 or fewer primary care physicians. 

Washington County has the third-highest number in the region with 350 primary care physicians, followed by Sullivan County with 303. The study estimated about 77 percent of the total physicians in East Tennessee were in those two counties, Hamilton County and Knox County.

Carter County listed 27 total primary care physicians.

“We’re certainly working on rural programs for medical students to try and draw them here,” Franko said.

The nation’s ongoing battle against methamphetamine could worsen the shortfall. 

Avalere Health’s physician-shortage study also analyzed the possibility of Tennessee enacting a new prescription requirement for medicines containing pseudoephedrine. 

“Placing new prescription requirement for current over-the-counter medicines containing pseudoephedrine would create an additional 33,137 new doctor visits in Tennessee,” the study read. It also estimated the new prescription requirement would cost $600,000 in new Medicaid spending and would result in $1.4 million in lost sales tax revenue during the first year alone. 

Oregon and Mississippi are the only two states that now require a prescription for dispensing pseudoephedrine, an ingredient used to make methamphetamine. The Government Accountability Office reported that between 2010 and 2013, at least 69 prescription requirement bills were introduced in 18 different states. 

Tennessee legislators recently passed a bill limiting the amount of pseudoephedrine that can be purchased, but no bill has been passed to require a prescription for all purchases.

However, several cities in Tennessee have taken action into their own hands and passed prescription-only pseudoephedrine local laws, including Harriman, Pulaski, and Altamont.

Franko said if the state did enact a prescription requirement it would likely burden already overwhelmed physicians. 

“It would create extra work without monetary benefit,” Franko said. “The system is very burdened with the needs of patients already and other demands. It’s tough to find a win-win.”

Dr. Katelyn Alexander, assistant professor in ETSU’s Bill Gatton College of Pharmacy, said the current uncompensated requirement for pharmacists to monitor the distribution of pseudoephedrine isn’t a burden at all. 

“I don’t think it’s really a big deal to use the system,” Alexander said. “I think from a pharmacist’s side, we want consumer access to pseudoephedrine products.”

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