Yesterday, Colorado U.S. Sen. Mark Udall introduced two amendments to the Senate health reform bill designed to boost services in rural communities.
“There are not enough doctors who want to practice outside major metro areas. In fact, of the 47 rural counties [in Colorado]—that’s out of 64 counties, total—all but three are designated by the federal government as health professional shortage areas,” he said.
Udall added that doctors simply make more money in the nation’s cities so it’s hard to lure them to communities outside of metro areas.
One of the amendments had been a separate Udall bill, the Rural Physician Pipeline Act, which aims to establish medical-school programs to train rural doctors. The second amendment would ensure that some of the prevention and wellness funds already in the health care reform bill go to rural communities.
Rural physicians, Health and Wellness
According to Udall, a 2008 study found that if all medical schools enrolled 10 students in programs that focused on rural medicine, the number of doctors in rural areas would double.
The first Udall amendment would provide grants to medical schools across the country to develop programs to train doctors for rural practice. The programs would be based on a program currently offered at the University of Colorado at Boulder.
“Primary care doctors in rural areas face challenges that urban doctors do not,” Udall wrote in a website post about the original bill. “When a physician is the only health care provider for an entire county, he or she cannot refer patients down the hall to a specialist.”
“The rural training programs encouraged by this bill would give students additional education in pediatrics, emergency medicine, obstetrics, and behavioral health, among other areas, which will allow them to better serve their communities and hopefully lower the disturbing disparities of health outcomes we’ve seen over the years. Obstetric training is particularly key for rural areas where specialized care for pregnant women is in great demand.”
The amendment would also encourage students from rural communities to attend medical school.
“So you recruit, in other words, students for medical schools out of the communities themselves,” he said.
Udall’s second amendment would ensure that some of the Community Transformation Grants, which are a part of a health and wellness provision in the current health care reform bill, would go to rural communities. The grants are designed to help prevent and reduce chronic disease in communities across the country by funding programs that combat obesity, tobacco use, diabetes and other health conditions or unhealthy lifestyle choices.
“It just makes sense. Rural America is equal in importance to urban and suburban America,” he said.
Estimating costs
Though the amendments have not yet been scored by the Congressional Budget Office, Udall predicted that they would have no immediate cost. In part, that’s because, while the Rural Physician Pipeline Amendment authorizes a program, it doesn’t actually allocate the funds to pay for it. Udall acknowledged that he would have to return to Congress to fund the program at a later date. He expected the initial phase of the program to cost $4 million per year over a five-year period, or about $20 million.
“Those are real dollars,” he acknowledged. “Those are not insignificant. But if you think about what the return is…if you double the number of graduating rural doctors, that would be very, very significant.”
The Community Transformation Grant amendment should have no cost, he said, because it simply re-allocates some of the $10 billion already being spent on health and wellness in the Senate health care reform package.
The Congressional Budget Office will have to confirm that the bills have no cost before the amendments see a vote, said Udall.
“But I’m optimistic,” he said. “The majority leader has expressed a lot of interest in this amendment. The rural communities and rural community advocates have been strong supporters.”
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