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Published June 22, 2013, 01:43 PM

Newly insured will worsen Dakotas doctor shortage

PIERRE, S.D. (AP) — North Dakota and South Dakota have struggled for decades with a shortage of family doctors in rural areas, and the gap between supply and demand is expected to grow as more people gain insurance coverage when the federal health care law takes effect next year.

By: CHET BROKAW,Associated Press, CHET BROKAW,Associated Press

PIERRE, S.D. (AP) — North Dakota and South Dakota have struggled for decades with a shortage of family doctors in rural areas, and the gap between supply and demand is expected to grow as more people gain insurance coverage when the federal health care law takes effect next year.

Each state already has a shortage of 100 or so primary care doctors. North Dakota has no primary care doctors in 17 of its 53 counties. South Dakota lacks family doctors in 19 of its 66 counties.

But both states have a variety of programs in place to increase the number of medical school graduates, encourage more to practice in rural areas and use physicians' assistants and other health care workers to provide care to farmers, ranchers and small-town residents who often live long distances from the nearest doctor's office.

The Association of American Medical Colleges projects the national shortage of primary care physicians will reach almost 30,000 in two years and will grow to about 66,000 in little more than a decade. An increase in people with insurance coverage could mean longer waiting times when they visit doctors' offices.

North Dakota now has an estimated shortage of 100-150 doctors, with family physicians making up about half that deficit, according to Dr. Joshua Wynne, dean of the University of North Dakota School of Medicine. The shortage is expected to grow to 300, or about 150 primary care physicians, in the next decade as an aging population requires more medical care, many doctors retire and a booming economy in North Dakota's oil fields and elsewhere swells the state's population, he said.

The federal Affordable Care Act will put more patients in doctors' offices, but it will have less effect in North Dakota than in many states because North Dakota has a relatively small number of people who have no insurance or Medicaid coverage, Wynne said.

"The robust economy has enabled a lot of people to get health insurance through their employment," Wynne said.

Gary Hart, director of UND's Center for Rural Health, said it's difficult to predict how many people who have avoided care until they were seriously sick will get insurance under the new federal law and start seeing family doctors regularly.

"There's no way of knowing until we get through some of this. We aren't doing great to begin with. We're short to begin with," Hart said.

The South Dakota State Medical Association estimates the state's shortage of primary care doctors is now somewhere around 100. The shortage of family doctors could reach 200 in the next decade, meaning an additional 20 a year need to be recruited to replace retiring doctors, care for an aging population and cover those who gain coverage under the federal health care overhaul, said Dr. Daniel Heinemann, the association's president.

Both Dakotas are expanding the size of medical school classes and residency training programs, offering financial rewards to new doctors and others who agree to practice in rural areas and helping small communities recruit doctors.

The North Dakota Legislature this year approved spending more than $120 million to build a new medical school facility and support an ongoing effort to expand the number of doctors and other health workers. The Medical School's class size expanded from 62 to 70 two years ago and will now expand to 78.

Wynne said North Dakota has to train more doctors, keep more graduates in the state, encourage people to lead more healthy lives, and develop a system that uses physicians' assistants, nurse practitioners and others to work with doctors in rural areas.

South Dakota also expanded its medical school class size from 52 to 60, and an effort is under way to boost it even further. Residency programs and other efforts encourage graduates to work in rural areas.

Heinemann said it's difficult to recruit doctors to rural areas because they can make a lot more money as specialists in large cities. The state needs to increase the income of primary care doctors, and that could happen as more clinics affiliate with large health systems, he said.

Dr. Stephan Schroeder, 62, is beginning to think about retiring from the practice he shares with two other doctors in Miller, S.D. He said his clinic is lucky because it recruited a medical student from Colorado to join the practice next year, adding that some young doctors are reluctant to practice in rural areas because they have to spend a lot of nights on call to handle emergencies.

South Dakota Health Secretary Doneen Hollingsworth said she's encouraged by the recruitment of every new doctor in a rural area.

"Every doctor we are able to place in a small community is a success, but it's difficult," she said.

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