Part 2: Pay Physicians More to Practice in Underserved Areas. (Attracting Qualified Physicians to Underserved Areas)‪.‬

OVER THE LAST QUARTER century, the strategies of building additional medical schools and, thereby, supplying more doctors; expanding the National Health Service Corps (NHSC) program; or, increasing the number of international medical graduates (IMGs) have not resulted in a sufficient number of physicians being available to deliver quality care to those in poor rural or inner-city environments. This is a view shared with Ginzberg, (25) Kindig, (26) Mullan, (27) Rivo, (28) Wennberg, (12) and Whitcomb, (29) in some cases for other reasons than those outlined in the first part of this article. Further muddling the situation is the mounting evidence of an impending surplus of physicians as a result of a continuing increase in the ratio of physicians to population; and, a surge in managed care enrollment, which signa]s needing fewer physicians per capita than was experienced with fee-for-service reimbursement. (30-32) Crime, drugs, HIV/AIDs, and poverty, often interrelated, are factors discouraging physicians from practicing in "tough" inner-city areas. The lack of suburban amenities and the social-cultural factors identified with farming communities experiencing economic decline are among the major deterrents to physicians locating their offices and living in poor rural areas. (33) In addition, the underserved generally experience more acute and chronic illnesses; obtain a significant percentage of their care episodically through hospital emergency departments; (34) rely, at best, on modest family support systems; possess limited funds to pay for medications and related items; find appointments during regular working hours, and obtaining transportation to and from physicians' offices, as possible road blocks to secure care; can experience difficulty in communicating effectively with physicians and allied health personnel; and, finally, may delay physician care until their illnesses become an emergency, To design a health care system that is a "rock solid" marriage between "reluctant" physicians and "difficult" patients is a monumental task.