How do we bring, and retain, physicians in rural NC? State lawmakers, health-care policy experts discuss during ‘Hometown Debate’

Daily Dispatch, The (Henderson, NC)

Oct. 19--HENDERSON -- During the fourth installment of this year's "Hometown Debate" series on health care, state legislators and policy experts had differing views on Medicaid and certificates of need laws, but easily agreed on one thing: attracting, retaining, and training physicians in rural areas is paramount.

The Institute of Political Leadership and the Henderson-Vance Chamber of Commerce hosted the statewide televised discussion, held at the Vance-Granville Community College Civic Center, centered around the delivery of medical services Thursday evening. Spectrum News Channel filmed the debate and Loretta Boniti moderated. Panelists included state Donna McDowell White (R- Johnston) and Terry Garrison (D- Vance), Henderson resident Greg Griggs of the N.C. Academy of Family Physicians and Jordan Roberts, a health care policy analyst from the John Locke Foundation.

Off the bat, all panelists established that health-care challenges weren't limited to rural communities, but that urban areas were affected as well.

White suggested that urban areas face affordability issues due to high population density, while rural areas face access issues as hospitals close and physicians move to more economically attractive locations.

"We've lost 28 percent of our primary care physicians in the state in the last two years," she said. "A lot of those have been lost in the rural areas because there's just not something to attract them to stay other than patient care."

Griggs sort of agreed, but opined that the largest issue was the ratio of primary care physicians versus specialists.

"There are certainly some commonalities, but our rural areas face a lot more difficulties," he said. "One thing that I think we can do better across the state [is] invest more in primary care. ... We only invest about 6 percent of health-care dollars into primary care. Primary care can be a really great way to prevent causes down the road."

Roberts offered another solution to "liberalize the licensing [to] allow out-of-state doctors to come in and practice," in hopes it would encourage doctors to come to rural areas.

"Also, we see that primary care physicians are getting burnt out," he added. "That's largely due to all the insurance paperwork and regulations they have to deal with. So I think addressing that and making primary care more lucrative will be an important step."

Boniti asked the group if too much oversight was making problems worse, and if CON laws were outdated and if allowing more competition would be beneficial.

White, first up, noted it was a hot-button issue in the General Assembly and that it was politically divisive even within each caucus, but didn't offer a clear stance on the matter.

However, Roberts was resolute.

"I absolutely think the Certificate of Need law should be repealed," he said. "When we talk about serving patients and access to patients, all the CON laws do is limit the supply and protect the incumbents that hold the CON.

"So, if we're talking about serving patients, we need to open it up and allow unfettered access to the market and that's the best way to serve patients in the long run."

Boniti directed a question at Garrison soon after, asking if, when speaking about patients that hospitals have to accept regardless of insurance status -- talking about CON, more competition, and whether or not folks can pay for this health care -- if that was more of a question on Medicaid.

"Yes, by and large it becomes a Medicaid question," Garrison replied, "and I think that pretty much justifies the need for Medicaid expansion."

But later on in the conversation, White again stressed the importance of more physicians in rural areas, pivoting from Medicaid conversations to first, supply of physicians.

"I think the elephant in the room is the fact that we are talking about health-care costs, but we are talking about availability of primary care physicians," White said. "That is one of the biggest issues. We can get so wrapped up in cost and whether we should expand Medicaid ... but if the physicians are not there, then it doesn't matter how much money you've got to pay them if they're not there."

She suggested training people from the areas with sparse health-care access is the best way to generate better services in rural areas. She, and the other candidates, all in agreeance, spoke about the need for more investment in recruitment, developing the local workforce, and supplying grants to help students pay for school.

"If you grew up in Eastern North Carolina, there's a good chance you'd like to live in Eastern North Carolina," White explained. "But if you grew up in a big city and you move to Eastern North Carolina and there's nothing there on Saturday nights except a festival, you're not going to stay."

Griggs responded, "She is right and it's a great point.

"If we can recruit people from our rural areas, get them to medical school in North Carolina and get them into residency programs in North Carolina and continue to expose them to rural practice, it's very clear they'll go back into rural areas," he said.

Nearing the end of the debate, when asked about views on telemedicine, all panelists were cautiously in support of the mode of service, noting it was a sure-fire way to begin to bring access to those areas most in need.

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