Bills address looming doctor shortage

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The entrance to North Valley Hospital in Whitefish. (Daily Inter Lake file)

Two bipartisan bills introduced by Sen. Jon Tester, D-Mont., to Congress last week aim to address the nation’s shortage of doctors in rural areas by tackling issues of residency, or the time an aspiring physician spends training at a hospital after finishing medical school.

In a recent press release supporting his bills, Tester said the physician shortage in rural America “threatens the future of frontier communities in Montana.”

The first bill, known as the Rural Physician Workforce Production Act, would lift caps on reimbursement payments to rural hospitals covering the cost of taking on residents. The ceiling has created a “serious disadvantage” for rural hospitals when trying to recruit residents, Tester said. The second bill, the Training the Next Generation of Primary Care Doctors Act, would supplement residency programs in rural areas with nearly $650 million over a five-year period.

The Association of American Medical Colleges estimates the United States could see a deficit of up to 120,000 physicians by 2030, which it says will greatly impact patient care across the nation.

The sting from shortages in physicians is one felt especially hard by Montana, where rural hospitals often struggle to recruit and retain physicians. According to Dr. Doug Nelson, chief medical officer at Kalispell Regional Medical Center, the state has about 2.2 physicians per 1,000 residents — a number that falls below the national average of 2.8 physicians per 1,000.

The location where one spends their residency — which can last three to 10 years — is a large determinant of where they will practice as a doctor, Nelson pointed out.

Nelson, who has also been a primary-care doctor in Flathead County for 26 years, said an aging population is largely to blame for nationwide and statewide deficits.

“There is no question that those over the age of 65 are in need of the most medical care,” Nelson said. “The demand for services is obviously not decreasing.”

The American Association of Retired Persons estimates that by 2040, one in five Americans will be 65 and older.

And Nelson said many physicians currently supplying that demand are rapidly becoming part of that aging population. The American Medical College report estimated one-third of the current physician workforce in the United States will retire within the next decade.

The Area IX Agency on Aging, based in Kalispell, reports the population of local seniors is growing rapidly. The agency estimated in past reports that come 2020, older adults will make up 26 percent of the population, but that number is already at 28 percent.

As for physicians in Flathead County, Nelson said the area is well-supplied to meet local demands.

“We [Kalispell Regional] have expanded the number of physicians significantly in order to provide specialty services that are not available in most of Montana,” Nelson said, such as the hospital’s pediatric gastrointestinal services, among others. “Those are scarce resources throughout much of the state and it’s a remarkable collection for a relatively rural area.”

Kalispell Regional also has its own residency program that continues to attract aspiring physicians — the Family Medicine Residency of Western Montana. It’s a collaborative program among Kalispell Regional, St. Patrick Hospital in Missoula and community health clinics in Flathead County and Missoula.

Nelson said every year the program attracts 10 residents, three of which complete their second and third years in Kalispell. Nelson said the majority of those brought in choose to stay and practice in Montana.

Kalispell Regional also offers a year-long rural surgery residency program. Participants expand their services to include those mostly offered by specialty doctors in major cities.

For instance, residents may learn how to perform cesarean section surgeries, which are often performed during births by an obstetrician gynecologist. But in more rural areas, where specialty surgeons are few and far between, those who are available are expected to perform an array or surgeries.

“Jack of all trades is a good way to describe it,” Nelson said. “They have to have a more diverse skill set in order to serve as a rural surgeon.”

Nelson said the rural Montana life is also something that works to the state’s benefit.

“What attracted me here 26 years ago and continues to attract our quality medical staff is the Montana outdoor lifestyle,” Nelson said.

Reporter Kianna Gardner can be reached at 758-4439 or

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