02.16.07
ANNOUNCES FIELD HEARING IN ANCHORAGE AND NEW LEGISLATION
WASHINGTON, D.C. – Senator Lisa Murkowski today spoke on the floor of the Senate and urged her colleagues to address the physician shortage crisis facing the Nation.
“In just 20 years, 20 percent of the U.S. population will be 65 or older, a percentage larger than any other time in our nation’s history,” said Murkowski. “And, just as this aging population places the highest demand on our health care system, the Council on Graduate Medical Education states that there will be a national shortage of over 100,000 physicians. Other experts predict a shortage closer to 200,000. If that becomes reality, 84 million patients will be left without a doctor’s care.”
Earlier this year, Murkowski introduced the Rural Physician Relief Act, a bill that provides tax incentives for physicians to practice in, and serve residents of, the most rural areas of the nation. Today Murkowski indicated she will soon introduce the Physician Shortage Elimination Act – a bill designed to:
• Double the funding for the National Health Service Corps,
• Improve and expand medical residency programs,
• Reauthorize programs that provide incentives for disadvantaged and minority students to pursue health professions, and
• Bolster community health centers in rural communities.
Murkowski also announced that that she will be chairing a Health, Education, Labor, and Pensions (HELP) Committee field hearing on February 20th in Anchorage. The purpose of the hearing is to investigate the shortage of primary care physicians throughout the nation, with a focus on rural communities.
“The prognosis for quality of healthcare in America is poor,” concluded Murkowski. “50 million Americans in underserved areas across the nation already must do without care. The time for Congress to act is now.”
The full remarks follow.
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Physician Shortage Elimination Act
Senator Lisa Murkowski
Floor Statement
February 14, 2007
In just 20 years, 20 percent of the U.S. population will be 65 or older, a percentage larger than any other time in our nation’s history. And, just as this aging population places the highest demand on our health care system, the Council on Graduate Medical Education states that there will be a national shortage of over 100,000 physicians. Other experts predict a shortage closer to 200,000. If that becomes reality, 84 million patients will be left without a doctor’s care.
A dozen states already report physician shortages. Across the country, patients are experiencing or soon will face shortages in many physician specialties, including cardiology, radiology and several pediatric and surgical subspecialties.
Demand for doctors is accelerating more rapidly than supply – yet the number of medical school graduates has remained virtually flat for a quarter century. During that same period, the median tuition and fees at medical schools have increased by 750% in private schools and by nearly 900% in public schools!
To add to that, much of the nation's physician workforce also is graying and headed for the door. A third of the nation's 750,000 active, post-residency physicians are older than 55 and likely to retire just as the boomer generation moves into its time of greatest medical need. By 2020, physicians are expected to hang up their stethoscopes at a rate nearly two and half times the retirement rate today.
Mr. President, a looming doctor shortage threatens to create a national healthcare crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases. People are waiting weeks for appointments and emergency departments have lines out the door. Many will go without care entirely.
In rural America, patients have long gone without care. In fact, the shortage of physicians, especially primary care physicians, in rural areas of the U.S. represents one of the most intractable health policy problems of the past century. As a result, rural patients are often denied both access to care and quality of care.
Mr. President, one-fifth of the U.S. population lives in rural America, yet only 9% of the nation's physicians are practicing in these areas. Over 50 million of these rural Americans live in areas that have a shortage of physicians to meet their basic needs.
Additionally, physician recruitment to rural America has also long been a problem. The high cost of medical school is in large part to blame - - most students, severely in debt after medical school, are forced away from primary care and into more lucrative specialty medicine. Rural areas and their community health centers across the nation report a declining ability to recruit primary care physicians.
In Alaska - - a state larger than Texas, California and Montana combined - - rural brings on a new meaning. The physician shortage crisis in Alaska has long been magnified. Health care delivery in the state is extremely difficult because, in part, there are fewer roads than any other state. (Even Rhode Island has more.) This means that for the vast majority of communities in Alaska, all medical supplies, patients and providers must travel by air.
Alaska’s population is growing, especially its elderly population, which is the second fastest growing in the nation. However, Alaska’s physician workforce, like others across the nation, is aging. The number of new residents is not keeping up with attrition. 118 physicians in Anchorage alone are expected to retire in the next ten years.
Currently, Alaska has the sixth lowest ratio of physicians to population of the United States. Outside of Anchorage, the ratio is the worst in the nation. To reach the national average by 2025, Alaska needs a net increase of 980 physicians statewide, or 49 more physicians per year.
In Anchorage, many specialties are in serious or critical shortage, including general internal medicine, neurology, neurosurgery, rheumatology, and infectious diseases. Patients wait for months to be accepted as new patients for general internal medicine, and others have to be flown to Seattle for some critical specialties.
However, there is a bright spot. Even though, Alaska has only one residency training program that trains 12 family medicine residents each year - - far fewer than our population needs.
Mr. President, in the last Congress, with great fanfare, we provided a Medicare prescription drug benefit. But what good is that benefit if there are no physicians to write a prescription? In the 21st Century, we cannot, as a government, permit such dire access to care to continue.
I believe this situation is intolerable. This body cannot idly sit by while potentially millions of patients go with care. That is why I am proposing a three-pronged plan to alleviate the nation’s rural health care access crisis. Earlier in the year, I introduced the Rural Physician Relief Act, a bill that provides tax incentives for physicians to practice in our most rural and frontier locations in the country.
Today, I am announcing a second step on improving access to health care. Soon I will introduce the Physician Shortage Elimination Act, a strong step in improving access to our health system. Later, as the third prong to my plan, I will introduce comprehensive legislation for improving the plight of the uninsured.
The Physician Shortage Elimination Act does four things:
• First and foremost, my legislation doubles the funding for the National Health Service Corps. This program has operated with 37 years of excellence - - providing primary care services to our most vulnerable populations. It’s a solution to the many students who find the exorbitant cost of medical school prohibitively expensive.
However, the program is just too small to meet the great need in underserved America. Right now, over 4,000 National Health Service Corps (NHSC) clinicians provide primary care to nearly 6 million people nationwide - - who otherwise would likely have gone without care. Tragically, this still leaves some 50 million people with extremely diminished access to health care.
In fact, the American Association of Medical Colleges said the current program only meets 12% of the need of the underserved. However, the program is so popular with medical students, that 80% of its applicants in a typical year must be turned away.
Mr. President, the National Health Service Corps has a proven track record. Why not build on its success? Doubling our investment in the National Health Service Corps is the most prudent, cost effective and expeditious way to meet the current needs and future needs of America’s underserved.
In fact, the former president of the AAMC stated that the National Health Service Core “is ideally positioned to alleviate the shortage of physicians in many medically underserved areas but has only had sufficient funding to accommodate only a fraction of those young physicians who are prepared to practice in those areas.”
• The second part of my bill will improve and expand current medical residency programs. Mr. President, half of all physicians practice medicine within 100 miles of their residency. This means that residents who train in rural or underserved areas are likely to remain in those areas. The small Alaska Family Residency Program, a program designed to help meet the needs in rural Alaska, is a shining example of this. Out of the 55 graduates, 77% have stayed in Alaska upon completing their residency - - the highest rate of return of any graduate medical program in the country! Unfortunately, the Alaska Family Residency is too small to meet the large needs of rural Alaska.
Mr. President, rural and underserved residency programs must be allowed to flourish. Arcane barriers and artificial caps on residency programs must be removed - - students must be allowed to learn their craft in the most rural and underserved areas of the nation. My legislation will prevent residency programs from being penalized for training in locations where the need is greatest - - such as Indian Health Service locations. Additionally, it will remove barriers that prevent programs from developing rural training rotations and rural experiences in their curriculum. Experts agree that this is the most effective way to prepare students for a rural practice.
• Further, my legislation will reauthorize the Center of Excellence program and the Health Careers Opportunity Program, which did not receive funding for 2006. These important programs target disadvantaged and minority students from as young as kindergarten (on through high school) - - to develop an interest in health professions. The programs nurture the youth in rural and underserved areas and create a “pipeline” to careers in the health professions. This concept of “growing your own” is the most effective way of achieving long-term retention in the most rural locations.
• Lastly, my legislation will bolster the cornerstone of health care in rural America - - the community health center. Community health centers provide quality, community-based health care for millions of America’s medically underserved and uninsured. My bill will help them do their job. Specifically, it will expand residency programs and primary care services offered by Community Health Centers and offer grants to health centers to assist them in recruitment, technical assistance and physician mentoring programs. Mr. President, a strong commitment to our community health centers is a smart, cost-effective way of maximizing our health care dollars for our neediest populations.
Finally, I am pleased to announce that the Senate HELP Committee, of which I am a new member, has agree to conduct a field hearing on the physician shortage crisis in rural America. Next week, the HELP Committee will hear from patients, providers and health care experts in Anchorage, Alaska on how the crisis is crippling health care in my state and in other rural areas across the nation. The Committee will hear compelling testimony of patients who cannot find a physician and testimony from the medical experts on the front lines as to how Congress can help resolve this crisis. I thank Chairman Kennedy and Ranking Member Enzi for making this important hearing happen.
Mr. President, the prognosis for quality of healthcare in America is poor. 50 million Americans in underserved areas across the nation already must do without care. Soon, even greater physician shortages will mean that another 84 million patients will be left without a physician’s care. The time for Congress to act is now. I ask my colleagues to support the Physician Shortage Elimination Act.
Thank you.
