Minn. faces shortage of primary care doctors

By STEVE KARNOWSKI, Associated Press

MINNEAPOLIS (AP) -- Primary care physicians are more readily available in Minnesota than most of the country, but experts say the state faces a looming shortage and only partly because of the federal health care overhaul that will extend coverage to around 300,000 uninsured residents.

Minnesota ranks ninth nationally in total active primary care physicians per 100,000 people, with 4,938 doctors to serve nearly 5.3 million people as of 2010, according to American Medical Association data. To the extent that access to primary care physicians is a problem in the state, figures from the U.S. Department of Health and Human Services point to the state's Indian reservations and some sparsely populated counties in far northern Minnesota.

The Minnesotans who will gain coverage under the Affordable Care Act aren't the main worry for Mark Schoenbaum, director of the Office of Rural Health and Primary Care at the Minnesota Department of Health. It's that, on average, Minnesotans -- and their doctors -- are getting older.

"The population is aging and will begin using escalating amounts of health services at the same time as the physician and related primary care workforce is also aging and will be retiring and leaving the workforce. So those mirror images create a precipice. We conservatively estimate that Minnesota will have a shortage of between 1,000 and 2,000 primary care providers by the early 2020s," Schoenbaum said.

"The estimated 300,000 newly covered Minnesotans using services contributes to that projection, but the underlying age dynamic in both the population and the health care workforce is the bigger contributor," he added.

And there's no short-term solution, said Dr. Jeremy Springer, chairman of a Minnesota Medical Association task force that's being formed to come up with recommendations for addressing the anticipated shortages.

That's because it takes a long time to train new doctors, said Springer, a family physician at Park Nicollet Medical Center in St. Louis Park and director of the family medicine residency program at Methodist Hospital. If a college senior decides to go to medical school, he said, it takes another seven or eight years before he or she enters the workforce.

Another complication, Springer said, is that the ups and downs of federal and state subsidies for residency programs mean that soon the state will be turning out more medical students than it will have residency slots for them to fill to complete their training.

"If we make changes now it's not really going to help us until 2021, so it's not easily solvable over the short term," Springer said.

Schoenbaum said the coming shortage will be broad and statewide. It may be noticed first in Greater Minnesota, he said. Family doctors, nurse practitioners and physician assistants -- rather than specialists -- handle a greater share of rural patients' needs. And he said those rural providers tend to be older than their urban counterparts.

But he stressed the entire state will experience the same problem.

One of the biggest things Minnesota has been doing to try to address provider shortages is to "rearrange how health care is delivered" by getting more efficiency out of the available workforce, Schoenbaum said.

The team approach to delivering health care is growing. The state has created some new health care occupations in recent years such as community paramedics and dental therapists to serve rural and underserved populations. The state also has trying to reduce demand for services by encouraging people to live healthier, lose weight, stop smoking and exercise.

"A multifaceted approach is needed to have any chance for responding successfully to this impending shortage," Schoenbaum said.