Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: FRIDAY, April 8, 1994                   TAG: 9404090006
SECTION: EDITORIAL                    PAGE: A10   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

UNDERSERVED

Everyone except the docs.

An urban practice - not too urban, of course; not inner-city - that produces an income of at least $180,000 a year, probably in a specialized field, and that allows the freedom and anonymity of a big city will do quite nicely, thank you. Who would turn down the substantially higher pay, or invite the hassle of running into patients everywhere in your personal life?

A few wonderful souls do, thankfully. But not nearly enough. There are fewer than 250 doctors serving 640,000 Virginians in what are called medically underserved areas of the state - rural and poor, inner-city areas.

Demand for universal health-care coverage has focused attention on the need for something even more basic - universal access to health care. No point having insurance if treatment is unavailable. And growing awareness that preventive medicine is essential to bringing costs under control has exposed a major weakness in the nation's overall health-delivery system: too many doctors replacing hearts; not enough ordering people to lose weight, quit smoking, exercise and avoid heart disease in the first place.

To their credit, Virginia's legislators did a few things in their most recent session to encourage medical students to pursue general practices in rural areas: They found a few million dollars to help medical schools recruit and train such students; expanded a scholarship fund statewide for those willing to set up family practices in rural Southwest Virginia; and created a loan repayment program (thus far unfunded) to help young doctors pay off their medical school debts in exchange for several years of service in underserved areas.

It's a start, anyway. As important, perhaps more important, is a commitment by the state's medical schools to increase the percentage of graduates going into general practice rather than more lucrative specialties.

Medical colleges can help make this happen. They can't make primary care pay better. But they can recruit students with an interest in primary care. They can increase the number of slots for these students, which will decrease the openings for those planning to specialize. They can value faculty members in primary-care fields, taking care not to canonize specialists. They can be sure students are exposed to good primary-care role models, as the University of Virginia is doing in requiring students to spend time with primary-care doctors.

The federal government can augment Virginia's fledgling efforts at financial incentives by offering loan-forgiveness plans that would let general practitioners start out under less of a debt burden. Debts of $50,000 or more entice many medical students to set their sights on the high-paying specialties. And Congress can end the discrepancy in Medicaid and Medicare payments between urban and rural doctors.

The federal government is looking for ways to reduce rather than increase the cost of these programs. But lawmakers must recognize that incentives are necessary to attract physicians to areas where they likely will be overworked, have fewer big-city amenities to offer their families and enjoy less opportunity for professional growth. A generally lower cost of living loses its advantage if remuneration is cut correspondingly.

Technology, with public and private effort, also has the potential now to link the most isolated practice to the latest medical advances.

An estimated 43 million Americans live in medically underserved areas. They should not be forgotten in the health-care reform debate.