There is a significant shortage of physicians, particularly primary care physicians, in rural areas which hurts communities in places like Nebraska’s Third District. There are three or fewer primary care physicians in 45 of the 75 counties in our district. Eighteen of these counties have no primary care physician at all. With so few physicians, rural Nebraskans may have to travel farther to see a doctor which can limit access to care.
Part of the reason for this doctor shortage is the challenge of recruiting physicians to rural areas. Many times, rural health care facilities simply do not have the resources to pay doctors salaries comparable to those at larger hospitals or more populated areas. While physician assistants, nurse practitioners, and other providers can provide some of the same services as doctors, many of the challenges of drawing physicians to rural areas apply to these professionals as well.
I recently visited one of the more than fifty Critical Access Hospitals in the Third District. These hospitals are designated as small, remote facilities providing 24-hour care. This hospital employs only one doctor who is ready to retire, but after more than a year of searching a replacement has not been found.
The hospital administrator estimates it will cost about $200,000 a year to hire a new doctor. This salary is increasingly unaffordable for the hospital because of costs related to implementing the Affordable Care Act, also known as Obamacare. Compliance with the medical records mandate included in the health care law alone will cost this hospital about $1.3 million. Numerous other mandates in the law will burden the hospital with costs, time, and lost productivity.
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These mandates further discourage doctors from working in rural areas. With fewer physicians and administrative staff, regulations disproportionately affect providers in rural areas more than in larger facilities with more resources and personnel to dedicate to compliance. Given the choice, it is not difficult to understand why a doctor would prefer to spend more time treating patients and less time filling out paperwork.
Another mandate which could further discourage physicians from taking rural positions are physician supervision regulations. These rules require a physician’s presence and supervision over nearly all routine procedures administered in hospitals. While this requirement is less of a challenge for large hospitals, it can be very problematic in areas with few doctors.
The Centers for Medicare and Medicaid Services (CMS) previously delayed enforcement of this rule for Critical Access Hospitals, however, last month the agency announced it would begin to enforce the rule at all hospitals. This week, I introduced legislation to delay this harmful rule for at least one year for Critical Access Hospitals, and until CMS completes an analysis of the impacts of this regulation. Physicians, nurses, and ancillary staff in rural facilities are highly experienced in determining the appropriate level of patient care. They must be given the flexibility to provide affordable and efficient health care.
Rural providers face many challenges without the heavy hand of government. The more government gets involved in health care, it is more difficult for doctors to do their jobs. To maintain access to quality care for rural Americans, we must do more to get the federal government out of the way of providers, and find ways to encourage more doctors to seek positions in smaller communities.