European Stars And Stripes (Newspaper) - July 11, 1987, Darmstadt, Hesse                                America s Rural doctor dilemma Bojoh Barbour associated press r. Jesse Walker of Ballico. Tenn., is 71. He was supposed 1o retire two years ago from the Indian Mountain clinic in thai poor Coal mining area of cast Tennessee there s no Ona to replace him so he hangs in. If two doctors walked in Here today he says we d Pul them to work  the irony the that the United states has More physicians than Ever before. We began the decade with about 460,000 physicians practising in the United states and we will end the decade with about 600,000," says Jeffrey human head of the National health service corps of the . Puttie health service. Yet there Are segments of the population either too poor or Loo Remote to receive adequate medical care. At the same time doctors who Long ago chose Rural practice Are finding their professional capabilities challenged by regional panels of doctors who find them unqualified under new medicare rules. The panels say thai their care fails to satisfy medicare standards. Some doctors have been censured out raging their communities. The Mutt it in these problem is that Many Rural communities already hurting for medical care Are being denied any care on the basis that what they have is inadequate. At the same Lime younger doctors flooding out of the educational pipeline have to be coaxed with government financial enticements to serve in Rural areas that desperately need their help it s never been easy to the Crit says Walker. And Many physicians still working in the Rural areas Are in their 60s or 70s. That s part of the problem  to understand this fragment of the a Lemma. One must understand the system of health care services in the whole. The National health strategy of Britain is National health service which entitles everyone to health service essentially free explains human. Tho National health strategy of the United states is one of reimbursement. We try to make services available but they Are privately provided for the most part and the costs Are reimbursed for the poor or elderly through medicare and medicaid the problem in some areas is it does t do you any Good if there s no physician there or there s no physician there that participates in the medicaid  three Federal programs work against this problem. The Community and migrant health Center program subsidizes health care for some. The Indian health care program under the Public health service continues a Long recognized obligation for those native americans. The National health service corps born of the spirit thai created the peace corps but Tong since changed attempts to deliver health care to under served Rural and Urban areas. There Are 3,300 Young corps doctors serving some z million patients nationwide originally the corps was manned by volunteers. Qut today Young doctors Are recruited under a scholarship program in which the Federal government pays for Lour years of their medical education in return Lor Lour years of service. However it is not a Giveaway under any circumstances the government drives a hard bargain. Ii a doctor Tor any reason defaults on the service obligation he or she must return triple the funds provided plus int Chest from the Day of Deposit at the maximum interest Rale available in the District of Columbia. The Justice Depar Lenl Brooks no excuses and Hal has put the program under some controversy since the scholarship program began some 13.300 have accepted those terms. Sut the numbers Are in decline. The Cummer of 1935 produced 1,600 recruits 1386 produced 1,200. This year there Are Only 900, furthermore most of these recruits will hit the Field seven years Down the line. Next year 1988. The corps will place Only 500 physicians and that will continue to decline says human. The corps has tried again to recruit volunteers but unfortunately they Are belter now at recognizing the volunteers who Are not the Best applicants for service so Many Are disqualified. There it a new program on the boards a loner payment program which allows the government to recruit at the end of a doctor s training the second or third year of residency. Residency is thai period in which a doctor specializes alter his four years of general medical training. This enables the government to make of cars for service closer to Iho finish line. In fact the government would pay up to $20,000 or each year of obligated service with a minimum of two years required. Studies have shown Hal Over 90 percent of doctors coming out of residency had significant debt in 1935. Up from 77. Percent in 1981 the average indebtedness has risen from $20,000 in 1381 to Over $30,000 in 1985, the leaner payment program in pending legislation would Cost no More in loto but would receive a doctor s commitment when it really meant something. The scholarship program asked prospective Doc ontto make a commitment seven years before the intended service. In the interim Art could happen and did. Some doctors chose or wanted to choose logo into surgery or oncology or some other specially which required forfeiture on their obligated service. The corps is interested Only in primary care dispensers internists family physicians obstetricians gynaecologists and paediatricians. Under the new program the government will be Able to go to Thost indicates whose specialities it requires we be plenty of doctors says Ray Davis who directs physician placement services in Tennessee but they re specialists and they re concentrated in Urban areas. They re cardiovascular surgeons in Nashville. That does t do much Good in Coffee fridge where people have lacerations and the children have  that aging or. Walker of Jellico is the Only one of the five doctors in his clinic who is not a National health service recruit. He reflects the problem in microcosm. Over 43 percent of the i army practitioners in Tennessee Are older than 55. In fact some 40 percent of the National service corps doctors Are absorbed into eight Southern slates Tennessee Kentucky North Carolina South card. Florida Georgia Alabama and Mississippi. Two thirds of he National health service corps doctors Ere now in Rural areas the most undeserved. The social consciousness of the 1960s has been in decline among All professional groups says health service corps chief human. We Are convinced that we Are spending too Lille Lime dealing with the socialization of physicians in medical  he Hopes that his regional starts will be Able to persuade medical schools and residency programs to incorporate More Community Medicine into their planning thereby increasing the social consciousness of their doctors. There arc Many people who Are afraid of 1he areas to which we would Send them says human not out of ear for their Salaty simply because the areas seem alien and threatening to them " not surprisingly studies show that minority doctors Are twice As Likely As whiles to serve in areas with physician shortages. Also graduates of Public medical schools Are More Likely to go to undeserved areas than Are graduates of private schools to make shortages worse medicare review has resulted in the disqualification of some Rural Doc Lofs who favo Boen lending Chstr a aliens