Auditor: Rural physician program needs improvements

Published 6:00 pm Thursday, August 24, 2023

By Devna Bose, Mississippi Today

A program aimed at increasing doctors in rural Mississippi communities isn’t effective enough, a new report from the state auditor’s office says.

As health care worker shortages continue, the program’s success could be crucial to improving the state’s persistent health care crisis.

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The Mississippi Rural Physicians Scholarship Program, established in 2007 by the Legislature and administered by the University of Mississippi Medical Center, awards money to medical school students for tuition or student loans. In exchange, recipients must spend one year practicing in Mississippi for every year they accept the money. A similar program focused on incentivizing dentists to practice in rural Mississippi followed in 2013.

Ideally, the programs would help close the state’s health care gap — half of all Mississippians live in medically underserved counties, according to a 2021 assessment from the state Health Department. Eighty of Mississippi’s 82 counties are federally classified as Health Professional Shortage Areas in either primary or dental care.

State Auditor Shad White speaking at the Neshoba County Fair, Thursday, July 28, 2022.

But according to State Auditor Shad White, the programs aren’t producing doctors and dentists fast enough. A former participant of the program, however, says it was never intended to solve the shortage entirely – the problem is too big and complex.

Data in the report show that the percent of need met for primary and dental care in Mississippi’s neediest communities has decreased over the past decade, despite more money being infused into the programs.

Fletcher Freeman, a spokesperson for the State Auditor’s office, said the programs, as they stand, are too small to be effective.

But participants like Dr. Jonathan Buchanan who moved home to Carthage in 2017 to practice family medicine said the programs are making significant changes in the communities they serve, despite the fact they are not solving the entire problem.

“I was the first physician to come back to this area in 26 years — that’s a generation’s worth of time,” he said. “Our program is currently somewhere in the 70 range of people graduated from the program and practicing, and if you asked each of those physicians, they’d say they’re making a tremendous impact on the quality of health care that rural Mississippians are receiving.”

The report takes issue with several things in particular: the programs’ definition of “rural” is too broad, and the commissions running the programs should maintain better oversight of them.

“We just don’t have the definition of ‘rural’ down,” Freeman said. “We’re using definitions when it’s convenient to potentially place doctors in Flowood.”

Though no participants have been placed in Flowood, the rules for the program allow for the Jackson suburb to be considered “rural” because of its small population. Currently, 10% of scholarship recipients practice in areas that the federal government doesn’t consider “rural.”

The report recommends adopting the federal definition of “rural” to ensure participants are placed where they’re most needed.

However, when the Legislature created the programs, they established commissions to oversee them. Those commissions decide how the programs work, including the definitions under which they operate.

Natalie Gaughf, assistance vice chancellor of academic affairs at the University of Mississippi Medical Center

Dr. Natalie Gaughf, the University of Mississippi Medical Center’s assistant vice chancellor for academic affairs, said “it has been determined that the federal designation of ‘rural’ is not adequate” to meet the state’s needs, and what’s currently used is based on an “understanding of Mississippi’s current and historic health care landscape.”

Mississippi towns that have a population of less than 15,000 and are located more than 20 miles from a “medically served” metropolitan area are eligible for graduates to be placed for work, she said, and every practice location request is reviewed individually.

Students who aren’t from rural areas are also eligible to receive a scholarship, though Gauphf said that all of the program’s recipients have “substantial ties” to rural communities.

Additionally, the report found that a quarter of rural physician scholarship recipients and 14% of dental scholarship participants have breached their contracts.

That can mean students did not complete their commitment requirements, or they chose a non-primary care field of medicine or chose to practice in a non-rural part of Mississippi or out of the state entirely.

Breaching the contract should result in the scholarship being converted into a loan with interest. However, the report found that the scholarship programs’ offices do not accurately monitor this data. Gauphf did not expand on the challenges associated with tracking these numbers.

According to Gaughf, 49 medical school graduates have breached their contract from the time the program was created to the fall of last year.

Freeman couldn’t say what provoked the first-time review of the programs, aside from gauging their general effectiveness and ensuring that taxpayer dollars are being put to good use.

Since the program’s inception, more than $33.5 million in state dollars have gone toward it.

“This report was meant to highlight basically efficiencies and inefficiencies in the program to maximize every dollar they receive,” he said.

Freeman said if the offices use the report to address the programs’ deficiencies, perhaps they’ll receive more money and be able to make more of an impact. According to Gauphf, changes based on the report have already been made, including at least one new form used to track individuals who breach their contracts.

The Legislature has recently expanded both programs, putting $2.17 million into the rural physician scholarship program and $420,000 into the dentists’ program in fiscal years 2023 and 2024, according to the report.

“It’s a good program that’s effective at producing doctors,” Freeman said. “Just not at the rate we need them.”

Still, it’ll be hard for the program to keep up with the rate physicians and dentists are choosing to leave the state or retire, which Gauphf said is “faster than the programs can produce graduates.”

Buchanan, the scholarship program alumnus practicing in Carthage, sees the state’s health care worker crisis as multifactorial and not something that can be solved through a single program.

“We just don’t have enough physicians, period,” he said. “But I think this is definitely a step in the right direction.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.