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How to Beat the Doctor Shortage

Big changes ahead for patients

New ways to attract new doctors

To make primary care a more attractive choice, medical experts are exploring a number of fresh ideas — from the more efficient team approach to shortening medical school training from four years to three. Today, Harvard is educating primary care doctors away from the doctor-sees-all-patients practice to a medical team model, which can lighten the doctor's workload and paperwork and still offer excellent care.

In Texas — where many small towns have only one doctor, if that — Texas Tech University is about to graduate its first class in an accelerated, three-year family medical program. Highly qualified students shave a year off med school and receive a full scholarship for their first year.

Clay Buchanan, a former lawyer, is one of those graduating in May. At 48, the Little Rock, Ark., resident is older than most medical students. He shadowed a family doctor as part of his training — and was hooked. "By noon the first day, I loved it," Buchanan says.

New York University and several other colleges are planning to experiment with a three-year program.

Health clinics offer primary care

Community health centers offer another form of primary care. Nationwide, the centers serve 20 million patients a year using a team approach, and are open to all on a sliding fee scale. Under the ACA, they are expected to double their capacity to 40 million patients by 2015. To entice doctors to work at these centers, the National Health Service Corps repays up to $120,000 in loans for each doctor in return for four years' service.

Technology, including telemedicine — which could reduce patient trips to the doctor's office — also should help expand health care.

Another way to increase health services is to give "physician extenders" — nurses and other medical professionals — more autonomy. Patricia Grady, director of the National Institute of Nursing Research at the National Institutes of Health, supports increasing the role of trained nurses, allowing them to set up independent practices where they could do physical exams and advise patients on exercise and diet.

But that position has met with some resistance. The American Academy of Family Physicians and the American Medical Association (AMA) favor training more physicians and nurses but want to keep nurses in teams led by doctors.

Nurses and foreign doctors

Permitting more foreign doctors to practice here also would increase the pool of primary care providers. Last fall, President Obama signed a three-year extension of a visa waiver program that allows states to place 30 foreign medical school graduates a year in "medically underserved" areas for three years. Most remain in the communities after they satisfy their commitment. Still, the shortage is so acute, even the AMA is lobbying Congress to increase to 50 the number of foreign-educated doctors each state is allowed.

In the meantime, more Americans are anxiously searching for a primary care doctor — or waiting months to see one. Marcia Andrews, whose Washington doctor refused to take Medicare, finally found a new doctor who does. The search took her 18 months.

Marsha Mercer is a freelance journalist who lives in the Washington, D.C., area.

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