"SHORTAGE AREAS" is the term used by the American Medical Association and others to describe those parts of the country that lack doctors. They are mostly rural places. In Minnesota, 297 rural towns have no doctors. In Nevada, citizens in 15 rural counties constitute 19 per cent of the population but are served by less than six per cent of the state's physicians. Throughout Appalachia, county after country has no doctor.
Nobody doubts that rural citizens surely suffer from this shortage of doctors. What is irksome is that they suffer more than they need to for the reason that the current Medicare law does not allow reimbursement for services provided by nurse practicioners and physician assistants. As written in 1972, the Medicare provisions within the Social Security Act require that a physician be present at the health clinic or facility if reimbursements, many rural health clinic have been forced to close; many more are threatened by closings. One of the ironies of the situation is that patients have been receiving excellent care from these physician extneders. In recent hearings before the House Ways and Means subcommittee on health, Dr. Jesse Walker of Clairfield, Tenn., said that 75 to 90 per cent of the patients at his clinic can be treated by the non-physicians. The patients, Dr. Walker added, feel they are receiving quality service.
Several bills to remedy this situation are now before the Ways and Mean Committee and the Senate Finance Committee. Immediate action is needed. As the Appalachian Regional Commission has warned, more than 40 of its 200 mountain clinics are seeing their grants run out this summer. The problem has to do not with unused or costly services but with Medicare payments' not coming to keep the clinics going. The commission has taken the lead in this issue and argues persuasively that if adequate health care can be provided by nurse practitioners and physician assistants - many of whom were trained in the past few years to fill the doctor void - then the least Congress can do is broaden the law to keep the clinics open.
Sens. Dick Clark (D-Iowa) and Patrick Leahy (D-Vt.) have proposed a useful bill that would offer a comprehensive approach. Many in Congress appear willing to allow reimbursement in clinics that are so remote and small that they can never support a fulltime doctor. But they are relunctant to reimburse the work done by nurse practitioners and physicians assistants at slightly larger clinics that do have full-time doctors. The latter account for the majority of th rural clinics nationwide. The Clark-Leahy bill would cover both types of clinics. Even then, rural of American would remain underserved. According to recent figures from the Department of Health, Education and Welfare, the nation has 3,019 rural medically underserved areas with only some 700 rural clinics among them.
The Clark-Leahy legislation has 54 co-sponsors. The quesion is whether the Finance Committee will take up the matter when it is expected to mark up the Medicare bill later this month. Not to address the issue is likely to mean that many rural citizens will find themselves short not only of doctors but of fail health workers.