Squeezing Blood from a Turnip: Health Care Reform & Kentucky’s Physician Shortage
Deloitte Consulting, a technology firm helping to establish the new Kentucky Health Benefit Exchange mandated by the Affordable Care Act (“ACA”), recently completed a review that paints quite a grim outlook for the future state of health care in the Commonwealth. According to the review, Kentucky needs 3,790 additional physicians (including primary care doctors and specialists), 612 more dentists, 5,635 more registered nurses, 296 more physician assistants, and 269 more optometrists to meet current demand. The numbers are stunning on their own, but in light of health care reform and Medicaid expansion, they are downright staggering.
In early June, Governor Steve Beshear announced that he would expand the state’s Medicaid program to cover an additional 300,000 Kentuckians, most working poor without insurance coverage. The state’s health benefit exchange is expected to help an additional 300,000 obtain insurance coverage. That is 600,000 Kentuckians who will soon be covered and seeking medical care. This problem brings to mind the old saying, “you can’t squeeze blood from a turnip”; Kentucky cannot meet these new demands when there is already a shortage.
Physician shortage in Kentucky is nothing new. In 2007, the Kentucky Institute of Medicine (“KIOM”) conducted an in-depth study of the state’s needs and demands for physicians in coming years. At that time, Kentucky needed 2,298 more physicians to reach the then-US ratio. Kentucky then had 8,981 active physicians, or 213.5 physicians per 100,000 population; the national physician workforce ratio was 267.9, ranking Kentucky severely below the national average. In August 2008, approximately 80 counties of Kentucky’s 120 were designated as under-served or designated as health professional shortage areas (“HPSA”).
Shortages can be linked to numerous factors, including earlier physician retirement age, an aging population, the demand for more elective procedures, and life-prolonging technologies. But Kentucky has been especially hard hit because of its large rural population. As early as 1998, it was recognized that there was a tendency for physicians to practice in affluent urban and suburban areas, creating a problem known as “geographic maldistribution of physicians.” This maldistribution makes it harder for people living in rural areas to obtain the care they need.
Despite this dismal outlook, there are steps being taken now to prepare for the influx of patients that will soon be seeking care in Kentucky. In my next post, I’ll explain what some health care entities are doing to attract physicians and possible options to meet the coming demand for more doctors.
 Council on Graduate Medical Educations (COGME)(1998). Physician Distribution and Health Care Challenges in Rural and Inner-City Areas. COGME.