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Pediatricians Needed in the Heartland

 |  By Cora Nucci  
   December 29, 2010

The week before Christmas, one of the happiest times of the year for families with children, a report came out of New Hampshire that, for rural families, was as sobering as a fly in the eggnog.

While much has been written about the nation's shortage of physicians, a report by researchers at the Dartmouth Institute for Health Policy and Clinical Practice and the Department of Pediatrics, Dartmouth Medical School homed in on specifics: kids in the heartland are lacking pediatric care.

The study, published in Pediatrics, examined growth in the primary care physician workforcefor children and in particular focused on the geographic distribution of theprovider workforce.

It turns out that between 1996 and 2006, the general pediatrician and family physician workforces expanded by 51% and 35%, respectively, whereas the child population increased by only 9%, the report says.

But here's the clincher: The distribution of providers is terribly askew. The report says, "Undirected growth of the aggregate child physician workforcehas resulted in profound maldistribution of physician resources."

Nearly 1 million children live in places where there are no local pediatricians. Those places tend to be rural and poor, the report says.

What's to be done? The authors say "Accountability for public funding of physician training should include efforts to develop, to use, and to evaluate policiesaimed at reducing disparities in geographic access to primary care physicians for children."

HHS took a step in that direction in October with a grant of $772 million for the construction, expansion, and renovation of community health centers. Over the next five years, the Affordable Care Act will provide $11 billion for this purpose. "The newly constructed or expanded community health centers will provide care to an additional 745,000 patients and much needed employment opportunities in both rural and urban underserved communities," Secretary Kathleen Sebelius said.

But without doctors to staff those facilities, the problem of adequate access to care will remain. Rural hospitals should take a look at the efforts of Sanford Health, the primary healthcare network serving the six-state Frontier region, which includes the Dakotas. Sanford has learned to grow its own doctorsAnd that's a great start to making sure the kids in rural areas are all right.

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