News: CJ Exclusives

Friday Interview: Rural Health Care

The Community Practitioners Program helps attract and retain doctors

In today’s Friday interview the John Locke Foundation’s Donna Martinez discusses the Community Practitioners Program with North Carolina Medical Society Foundation CEO Bob Seligson. The interview aired on Carolina Journal Radio (click here to find the station near you).

Martinez: Now, the Community Practitioners Program recently got a big boost. Tell us about that.

Seligson: Yes, Blue Cross Blue Shield of North Carolina just granted the foundation a $10 million grant over a five-year period, and we are to match that grant with an additional $5 million over that time period. The uniqueness of this grant is that it is to be used for endowment money, which means it will help sustain the program forever, hopefully. That is one of the things that separates it from other various contributions made by other people. It will allow us to have operation money to operate the program on a daily basis. The program started in 1989 with a single grant by the Kate B. Reynolds Foundation Charitable Trust in Winston-Salem. And what the program is designed to do is to provide incentives, if you will, for doctors to be recruited to serve in the rural areas and economically distressed areas of the state to help meet the needs of the uninsured. And as a result, what we do is, we recruit doctors and provide them with opportunities and communities to live in, and in return for a five-year commitment, we help to pay up to half of their medical student loans.

Martinez: Oh, my goodness, that’s quite a commitment to a doctor — half of their student loans.

Seligson: Well, certainly, when you think of when doctors come out from $50,000 to $100,000 dollars in debt, and starting a new practice and dealing with the root realities of opening a new practice, certainly in a rural area, it creates some major challenges to overcome.

Martinez: Why is it so difficult to recruit or retain a doctor in a rural community? I mean is it as simple as the fact that people, in general, prefer to live in big cities?

Seligson: Well, certainly, Donna, that’s part of the problem. I think the uniqueness of being an urban area, where you have malls and movie theaters and things like that, that you don’t have that easy access to in the rural areas, is certainly a deterrent. I think the other aspect is trying to maintain a viable practice. You’ve got to have enough patients that are paying for their health care to keep your practice open. Doctors are small businessmen, in essence, because they have to pay overhead, they have to pay salaries and their benefits, and they have med-mal [medical malpractice] insurance to pay. They have the pressures from managed-care companies — you know, downward reimbursement. So there are real challenges that doctors have, even more so that are insurmountable in the rural areas.

Martinez: How many doctors are involved in the program?

Seligson: Well, since its inception, we have placed over 326 doctors, physician assistants, and nurse practitioners throughout North Carolina in about 123 communities, which 76 of those communities are categorized as economically distressed.

Martinez: Do the doctors stay once they’ve fulfilled this commitment?

Seligson: That’s a great question, one we’re proud of and it’s kind of the core of the program. We really spend a lot of time recruiting the right person, hoping that they will do just that — stay in the community after they have fulfilled their five-year commitment. And statistics have it 64 percent of the doctors we’ve placed in the rural areas actually stay there after their commitment is over with, because they’ve become part of the fabric of the community, become very involved and very part of the community activities, and plus they’ve grown to love living in the rural area and stay.

Martinez: Let’s talk about some challenges with health care in general. Now your organization, the North Carolina Medical Society, represents doctors, physician assistants.

Seligson: That’s correct.

Martinez: Let’s talk about this issue of cost. Health savings accounts is a relatively new solution that has been implemented, where people can get a low-premium, high- deductible insurance policy — essentially a catastrophic coverage policy. What are your doctors saying about health savings accounts?

Seligson: Well, I think there are pros and cons. It’s a little bit early yet to determine if they’re going to be — how effective they’re going to be out in the communities. But it’s certainly a viable option that we’re hoping will work. I think the real issue when you’re talking about health care costs and trying to assure — that we as a society have to take more self-responsibility to take care of ourselves. The majority of the illnesses that present themselves in doctors’ offices are due to unhealthy lifestyles or not exercising, not eating right, you know? Obesity — you know, people started coming out just a couple years ago about childhood obesity and that shouldn’t be a wonder when you walk into a grocery store and see 90 percent of the food in there is not good for you.

Martinez: Right — we’re all reading labels these days.

Seligson: Yeah…but, you know, we have a self-responsibility in prevention, to take better care of ourselves and that’s going to help address some of the rising cost. But healthcare is expensive — because one of the most advanced healthcare systems in the world, and because of the numbers of pharmaceuticals out there, advanced medical techniques, new discoveries everyday — we have very knowledgeable consumers that have access to things that they go ask their doctors about. The consumers are driving a lot of the consumption of healthcare services.

Martinez: In fact I notice on television, we now have what I consider to be this phenomenon, where you have drug companies actually advertising directly to the consumer versus trying to market their new drug to a doctor’s office.

Seligson: Right. There is some of that going on. We certainly have addressed our concerns to the pharmaceutical companies, but that in turn has at least exposed citizens to a lot more drug products available, and they ask about them and inquire about them. It certainly does initiate a lot of interest in drugs that some people might never have considered were ever even in existence.

Martinez: Now let’s talk about the uninsured. We hear a lot of numbers bandied about — anywhere from 40 to 46 million that are technically classified as uninsured in this country. Who are the uninsured based on the data that you have access to?

Seligson: Well, basically a lot of the uninsured have full-time jobs. I have a 23-year-old daughter that doesn’t have insurance. Her employers don’t offer it, and so we have to help give her some subsidization to help purchase insurance. A lot of people have paying jobs and no benefits and can’t afford their health insurance.
In North Carolina, it’s estimated over a million of our citizens are either uninsured or under-insured. And the Shep Center — the UNC Shep Center — has predicted a primary care shortage of physicians over the next several years, which will exacerbate the problems even more because, certainly in the under-served areas, in the rural areas where you need these primary care doctors, there is going to be less to recruit from. So, we hope our program will help change that and get physicians more involved in these communities that are projected to have less doctors in the future.

Martinez: That’s a really intriguing point. Why are we facing a shortage of doctors? I mean, I think the impression that some of us have, as a lay people, is that being a doctor is very lucrative, and that a lot of people are trying to get into medical school. Are we wrong?

Seligson: No. I think the demand for people entering into medical school is still on the rise. It’s still a waiting list and it’s very competitive, as we want it be, because we want the best and brightest going to medical school. But I think the other issue that you would deal with is, the economic realities of maintaining the practice. As I have referenced earlier, in the rural areas it’s hard to keep a practice afloat. And so one of the things that our community practitioner programs are doing to help deal with that, if I may lead to that very quickly, is we’ve implemented a project called Project Sustain, which, not only is the community practitioner going to help place doctors in the underserved, economically distressed areas of the state, but we’re also going to give them practice management techniques to help them be more successful in their endeavors, so they can maintain a viable office practice.

Martinez: And if people want more information about the program, your website address?

Seligson: [Go to] and then click onto the foundation. It will get you right there.