Nebraska has increased its number of health care professionals over the past 10 years, but 13 counties still have no primary care physician.
The University of Nebraska Medical Center issued a state health care workforce report last week with mixed findings. The numbers of many health care occupations, such as physicians and nurse practitioners, are way up in the state. Still, there are areas with a dearth of medical care.
Nebraska isn’t unusual. Country doctors and rural hospitals are in decline in many places. The University of Iowa reported that Iowa has two counties with no primary care physicians, Worth and Taylor, and seven with only two.
Doctors don’t want to be the sole practitioner in a community and be on call 365 days a year, said Dr. Mike Sitorius, chairman of family medicine at UNMC. Some areas have too few residents to make a medical practice profitable, he said.
“Frankly, I was impressed with the progress that has been made,” Sitorius said of the UNMC report’s findings.
Dr. John Cullen, president-elect of the American Academy of Family Physicians, said he works with three other physicians in Valdez, Alaska. They would like to have a fifth because they staff their own offices, work the hospital emergency room, visit hospital patients and deliver babies, among other duties.
Cullen wasn’t surprised that 13 Nebraska counties have no primary care physician. “Unfortunately, that’s true across the country,” he said. “Unfortunately, this problem is likely to get worse.”
Keya Paha County in northern Nebraska is one of the counties without a physician, physician assistant or nurse practitioner, the report says.
Linda Mundorf, who with her husband owns Town and Country Market in the town of Springview, said she drives about 50 miles to the town of Gregory, South Dakota, to see a physician.
“You’re not as apt to go as if you lived in the same town,” Mundorf said. “That’s just life in a rural area, I guess. There’s pros and cons.”
Finding a disease such as colon cancer early can be the difference between more effective care and complex, extensive treatment, said Fernando Wilson, lead author of the report.
Wilson, acting director of the UNMC Center for Health Policy, said the good news is the numbers of health care professionals are trending up. Ten years ago, when UNMC did its last state workforce report, 18 counties had no physician.
“The question is, is the workforce increasing enough? That’s a concern,” Wilson said. “I think a lot of these indicators are going in the right direction.”
The report contained these findings:
» Last year 4,827 physicians, including specialists, practiced in Nebraska, a 19 percent increase from 4,056 in 2007.
» In 2017, 908 physician assistants worked in Nebraska, up 52 percent from 598 in 2007.
» Nurse practitioners, who gained the right to practice independently in Nebraska in 2015, increased 50 percent, from 767 to 1,148.
» The number of dentists actively practicing in the state went up about 7 percent, from 1,011 to 1,077.
» And the number of pharmacists rose from 1,682 to 2,066, an increase of 23 percent.
UNMC is the primary training spot for many of the state’s health care professionals. The institution trains 54 percent of the physicians in Nebraska, Wilson said.
Sitorius said it’s not realistic to expect every county in Nebraska to have a primary care physician. The days of the one-man office are gone because of the exhaustion brought on by being constantly on call, Sitorius said.
Further, “you have to have a certain population to make it economically viable,” he said, and to provide enough variety of cases for doctors to keep their skills sharp.
Many physicians practice in Douglas and Lancaster Counties, the only counties in the state that aren’t officially designated by the State of Nebraska as official shortage areas in a primary care practice. Primary care includes family medicine, internal medicine, obstetrics-gynecology and pediatrics.
Wilson and Sitorius said that to continue the surge in doctors, nurses and other workers, UNMC needs to maintain and expand grow-your-own programs such as the Rural Health Opportunities Program; maximize the use of telehealth; and the state must retain and broaden loan repayment programs for those who choose to practice in rural areas for a given length of time.