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Doc program targets need in rural areas

Thousands of health-related jobs go begging in the rural South, creating a social drag on the economy, which drives the ambitious and creative people away to the major cities.

But a tiny little project to deliver young foreign doctors to small towns might be the first tiny step toward reversing things. It's an idea shepherded by a Memphis immigration lawyer and a new economic development agency headquartered in Clarksdale, Miss., organized with a new philosophy.

It says that economic development doesn't start with coaxing a factory out of Illinois, but with improving basic services such as health care and education. That leads to a better work force which can attract private sector development.

"Just one big problem is that the Delta has the worst physician distribution problems in the United States for primary care and specialists," says attorney Greg Siskind. "With nurses it's an across-the-board shortage while doctors are still in a distribution problem because they flock to urban areas; it's very hard to get an American physician to go to a rural area."

Meanwhile, the United States is sending home 8,000 American-trained foreign physicians each year, if they like it or not. And 8,000 new docs are imported to replace them. Universities and hospitals have to fill 23,000 residency slots each year, but American medical schools mint only 15,000 new doctors a year. Foreign docs take up the slack.

	Hospitals, Physician Practices
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Hospitals don't like to admit it, but residents are a source of cheap labor, in an era where reimbursements are falling. Medicare pays about $70,000 a year for resident training, with half of that gong as salary to the doc and the rest for administration.

Siskind says the program fails on the back end. After residency is complete, most of those trained doctors must return to their home country for two years before applying to return to the United States.

Foreign physicians overwhelmingly consider residency training in the United States as validation of their talent and skill. Only the top 5% of medical graduates in the world can even be considered for American residency.

Half of foreign doctors come from India, which Siskind says is opening new schools at a rapid pace and hopes to turn physicians into an export industry.

A few are able to extend their work visas if they take jobs with the Department of Veterans Affairs or the Indian Health Service. A small handful get hardship waivers, often because they've started families during extended training, and their children are natural born Americans.

Until recently the Department of Agriculture ran a program that placed foreign doctors in rural areas, straining to justify it as rural economic development that affects farmers. But that was limited to just 20 doctors a year per state.

Tennessee alone has more than 300 unfilled physician jobs each year.

"USDA closed theirs late last year," Siskind says. "It was just one person; the program was unfunded, and there was not a lot of support for it within the agency. They claimed they didn't have resources for background checks; nonsense because the FBI did it anyway."

It was then that Siskind approached the new Delta Regional Authority and proposed that it pick up the program that USDA dropped, with some modifications. What they came up with still awaits a final blessing from the State Department and agencies within the Department of Homeland Defense.

It would allow up to 30 foreign doctors a year to be placed in communities in each of the eight states that are part of the DRA. Docs would have to give a three-year commitment to stay in the community, and even if they are a specialist, they would have to provide 40 hours a week of primary care. Doctors that accept a five-year commitment would have the opportunity for permanent resident status, a big step toward becoming a citizen.

"Right now we need primary care," Siskind says. "If they're trained and they want to do nephrology or cardiology on the side, that's fine with us."

Primary care in this instance is: internal medicine, family practice, pediatrics, OB/GYN and psychiatry.

Two doctors are already lined up as candidates: a family doctor in Oakland, Tenn., and a nephrologist in Clarksdale who's willing to provide primary care services.

Jim Ainsworth hopes the effort works, but also hopes it won't be long before specialists can be included. As vice president and market leader for Mississippi for Baptist Memorial Health Care Corp., Ainsworth is responsible for four hospitals and about 600 beds.

Rural clinics need primary care, but he's got his own physician crisis, especially in anesthesiology and cardiology. Soon, he'll face a critical shortage of OB/GYNs.

"Part of the problem is the malpractice issues; we're having difficulty getting physicians who want to come to Mississippi because of tort issues," Ainsworth says. "We have an OB with a good claims history and two years ago his premium was $63,000. Last year it went to $162,000 and when the policy expires March 31, he's being told to expect a renewal above $285,000."

Mississippi tort reform went into effect the first of the year with an array of damage limits. So many suits were filed in the closing days that it may be five years before they're all settled. That's another five years of high premiums to pay off the awards.

Filling all the vacancies with foreign doctors, he says, is not practical from a cultural point of view. Doctors from India or Pakistan serve residencies in large urban centers like Memphis where people are accustomed to encountering foreigners. It might work in Oxford, where the Ole Miss faculty is peppered with international people, but filling needs in more rural areas could be difficult.

"It's going to be much more of a challenge for visa doctors to fill the gaps compared to someone who grew up in the community," Ainsworth says.

CONTACT staff writer Scott Shepard at 259-1724 or sshepard@bizjournals.com