The State Takes Aim at Family Practice, where Rural Areas Feel the Pinch

August 22, 2016
Dr. Jeffrey Bacon works at the Sterling Family Care Clinic and is spearheading the state's rural track training program there to try and recruit and retain rural family doctors.Dr. Jeffrey Bacon works at the Sterling Family Care Clinic and is spearheading the state's rural track training program there to try and recruit and retain rural family doctors. Bente Birkeland / RMCR
Dr. Jeffrey Bacon works at the Sterling Family Care Clinic and is spearheading the state's rural track training program there to try and recruit and retain rural family doctors.

Access to quality healthcare – and a doctor – can be difficult in the more rural parts of Colorado, especially along the eastern plains. That's why the state is embarking on a new training program to recruit and train more family practice physicians.

Dr. Jeffrey Bacon is spearheading the program in Sterling. He has been a family practice doctor for 18 years, the last 16 of those years at the Sterling Family Care Clinic.

"It's difficult to get people to come out and stay and retain here," Bacon says. "The critical piece as well is if you can bring them back and see that they can have their passion in a small town, and do what they want to do in a small town, it makes a huge difference."

"The data... suggests Colorado is going to need 49% more family physicians by 2030."

But location is just part of the problem. Overall, the number of family doctors nationwide has been declining for a while. Wanda Filer is the president of the American Academy of Family Physicians. She practices in York, Pennsylvania. She says it is still the most common choice for med students.

"We have over 11,000 residents right now, but that's still not enough because the population is growing. The data I've seen from our own work suggests Colorado is going to need 49% more family physicians by 2030," says Filer. "So there should be a strong state interest here to make sure family residency programs get what they need to expand and medical schools accept those students who are most likely to choose primary care."

State leaders have already commissioned a study looking at the current doctor shortage and what can be done. The group released 14 recommendations on various topics, including funding a new program to provide loan repayment assistance for medical students who decide to practice in the state after residency.

"It's probably a bit more challenging to get people to work in a rural areas than it has been in the past," says Amy Downs, vice president of the Colorado Health Institute, a non-partisan healthcare think tank in Denver.

"You have more females going into the primary care workforce and they're less likely to select rural areas. You also have the issue of primary care clinicians very often being married to a professional spouse who sometimes might have a challenge finding a position in a rural area."

"If you can bring them back and see that they can have their passion in a small town, and do what they want to do in a small town, it makes a huge difference."

That's a problem across rural parts of the state, and especially along Colorado's eastern plains. Downs says that region would need a 130% increase in doctors just to keep up with the industry benchmark of 1900 Medicaid patients per physician. She said Tele-medicine can help, but that doesn't take the place of an onsite physician.

"It takes a special person to do this out here because you're on your own," says Adam Mackintosh. Mackintosh has lived in Sterling for ten years but grew up outside of San Francisco. He admits that it took time to get used to practicing medicine in this setting.

"I don't have a big hospital 15 minutes away down the road. If we have a baby that is sick we have to hold them and keep them safe until we can get the guys out of Denver, that could be two hours or if there's a snow storm which seems like there always is when it's the worst, it can be 24 hours," says Mackintosh.

A new state law is aimed at helping the shortage. It created an income tax credit for people who teach and train medical students who want to go into family medicine. 

Residents Natalie Krier and  Pete Banchuin work as interns at North Colorado Family Medicine in Greeley. But they will spend the final two years of their residency in Sterling as part of a new rural track training program for family physicians.Credit Bente Birkeland / RMCR
Residents Natalie Krier and Pete Banchuin work as interns at North Colorado Family Medicine in Greeley. But they will spend the final two years of their residency in Sterling as part of a new rural track training program for family physicians.

The state commission also recommends other items such as a tax credit for physicians who practice in rural areas and loan forgiveness. Pete Banchuin is an intern at North Colorado Medical Center in Greeley, and one of two residents that will soon spend the next two years working in Sterling. It's part of a new rural track residency in Colorado that gives residents more time to understand rural life and what it means to practice there. However, Banchuin is somewhat unusual because he says he knew he wanted a remote area.

"On the east coast it's almost unheard of for a family doctor to participate in or do primary C-sections. That's all covered by OBs because along the east coast it's so specialist heavy. But when you get to these truly very rural areas, the breath is a lot wider," says Banchuin.  "You get a chance to do things and train in things that I would not otherwise get to do."

The American Academy of Family Physicians says it helps to train residents in the type of setting where they would likely practice. Paying doctors better is another way to attract those who are driven to more lucrative specialties. To that end, Wanda Filer said there is some good news; salaries for family physicians have gone up by 17% over the last year.