Government Policies May Drive Doctor Shortages in Unhealthiest States
State medical boards, government-protected monopolies, and jackpot juries could be keeping doctors out of Arkansas and Mississippi.
Two of the country’s unhealthiest populations live in states experiencing extreme doctor shortages, according to reports by two organizations ranking patient health and patient care among the states.
The dearth of health care providers is most prominent in rural states with widely dispersed populations, such as in many parts of the Southeast, according to the 2015 State Physician Workforce Databook, an AAMC study.
Mississippi has the nation’s lowest ratio of doctors to population, at 184.7 per 100,000 people, the study found. Arkansas is fifth from the bottom, at 198.1 per 100,000 people.
Mississippi and Arkansas are the 49th and 48th healthiest states, respectively, among a cluster of Southeastern states ranked among the least healthy by the United Health Foundation’s 2015 America’s Health Rankings Annual Report. Others are Louisiana (50), Alabama (46), Kentucky (44), Tennessee (43), and South Carolina (42).
State Board May Squash Growth
Jameson Taylor, vice president for policy at the Mississippi Center for Public Policy, says state regulations prevent health care providers from offering many services they are qualified to provide.
“The practice of medicine, whether it be by physicians, nurses, or even acupuncturists, is overregulated,” Taylor said. “If we allowed nurse practitioners to practice up to their full training, we’d almost instantly increase the supply of health care in rural areas. But the Mississippi Board of Medical Licensure has aggressively fought such reforms.”
The Mississippi State Board of Medical Licensure (MSBML) has also impeded the spread of telehealth to rural patients, Taylor says.
“Telemedicine could be used to provide high-quality care to patients all across the state, as long as they have phone service,” Taylor said. “But the Board is trying to squash telemed, as well.”
‘Desperate to Protect Its Monopoly’
MSBML has also prevented caregivers from working pro bono, Taylor says.
“The Mississippi Center for Public Policy worked on legislation this past session that would have awarded continuing medical education credits and some degree of liability protection to health care professionals who offer no-cost care to patients,” Taylor said. “The bill would also have allowed out-of-state physicians, eye doctors, and dentists to provide charity care in Mississippi.”
The legislation, Senate Bill 2782, passed the upper chamber 33–15 in February and was sent to the House for consideration. Taylor said opposition from MSBML deterred House lawmakers from voting it out of committee before the regular legislative session adjourned in April.
“Let that sink in for a moment,” said Taylor. “The Medical Board is so desperate to protect its monopoly that it is fighting to keep doctors licensed in other states from treating nonpaying patients.”
Dread for Med School Grads?
In neighboring Arkansas, up to 115 students will enter Arkansas State University in Jonesboro, the state’s second medical school, when it opens in August in partnership with the New York Institute of Technology College of Osteopathic Medicine, a private osteopathic institution.
Daniel Greenberg, president of the Advance Arkansas Institute, says the future graduates are heading toward a market distorted by excessive demand created by government entitlements and half-measure reforms.
“Medicaid expansion is a huge factor in health care shortages,” Greenberg said. “Advocates of Medicaid expansion told us that we’d be getting medical savings accounts for this new class of [Medicaid] recipients, which would have injected market discipline into the system. They lied. The only choice that these have is the choice between which insurance company will pay for their Medicaid benefits.”
Arkansas’ litigious political culture further constricts the flow of health care professionals to Arkansas and increases the cost of practicing in the state, Greenberg says.
“Our legal culture, coupled with an aggressive state supreme court, historically has disfavored mainstream civil liability policies,” Greenberg said. “More than half the states have some kind of limit on noneconomic damages for medical malpractice,” meaning compensation for pain and suffering or emotional trauma.
“With Arkansas, the sky is the limit,” Greenberg said. “If you can convince a jury that your pain and suffering is worth $100 million, you can get it. There’s a threat of bankruptcy every time a health care defendant gets hauled into a courtroom.”
The Arkansas General Assembly adjourned in May, and the Mississippi Legislature adjourned in June. Each will reconvene in January 2017.
Ben Johnson (firstname.lastname@example.org) writes from Stockport, Ohio.
“State Information,” America’s Health Rankings Annual Report, United Health Foundation, 2015: http://www.americashealthrankings.org/states
2016 Update: The Complexities of Physician Supply and Demand: Projections from 2014 to 2025,
Association of American Medical Colleges, April 5, 2016: https://www.heartland.org/publications-resources/publications/2016-update-the-complexities-of-physician-supply-and-demand-projections-from-2014-to-2025
2015 State Physician Workforce Databook, Association of American Medical Colleges, November 1, 2015: https://www.heartland.org/publications-resources/publications/2015-state-physician-workforce-databook
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