By  Rod Guajardo and Josh Bergeron

NATCHEZ — John Smith is just what the doctor ordered for the Miss-Lou.

Smith is one of the few medical school graduates who resisted the temptation of practicing specialized medicine at a big city to become a small-town doctor.

Unfortunately, fewer graduates are receiving a prescription to practice general medicine in rural areas — leaving a potential shortage of Miss-Lou physicians in the years ahead.

The Association of American Medical Colleges estimates 176 active physicians per 100,000 residents practice in Mississippi — ranking the state 50th in the nation.

In Louisiana, the AAMC estimates 232 active physicians per 100,000 residents practice, leaving it 30th in the nation.

Physician shortages are predicted to take an even sharper decline across the country.

The AAMC predicts the nation will experience a shortage of 124,000 full-time physicians by 2025 because of population growth, aging and other factors.

But Legislative initiatives in Mississippi and Louisiana that encourage students to become primary care physicians in rural areas by paying their student debt and continued physician recruitment by local hospitals are what state and medical officials hope can help solve the problem.

Cause for concern

Natchez Community Hospital CEO Eric Robinson said a recent analysis completed showed the hospital will need 17 new physicians in the next three and a half years because so many physicians will be retiring.

“I wasn’t surprised by the results because I’ve worked in other locations and regions in Mississippi and seen similar numbers,” Robinson said. “While physician shortage is a nationwide issue, Mississippi does rank last as far as having the greatest physician shortage in the country.”

Apart from a shortage of medical schools for students to attend in the state, Robinson said the population of uninsured residents in Mississippi also plays a part.

“It’s not like they’re greedy people, but they do have significant student loans to pay off and some physicians decide that it may be easier to make better income in another state,” Robinson said. “If you’re in an area with a high uninsured population, your physicians will get paid less.”

The U.S. Census Bureau estimates that 18.2 percent of Mississippi’s population is uninsured — the ninth highest in the nation.

Robinson said his staff would continue to actively recruit more physicians to the area in hopes of nipping the problem in the bud.

“I don’t want anyone to be alarmed thinking that they’re not covered because they are, but it’s in no one’s best interest to not be aware of the potential risk and not start working on it now,” he said. “It’s a conversation I have with our local physicians all the time.”

Sarah Smith, Director of Physician Relations and Recruitment for Natchez Regional Medical Center, said the decline in the number of physicians is not rare for Natchez.

But Smith said she believes Natchez has more to offer than other rural areas in similar situations.

“We’ve got a great opportunity to recruit younger doctors than other areas because Natchez has so many things going for it,” Smith said. “There are so many more things here as far as events, arts and things like that than maybe some other rural areas, so I think we definitely have physicians looking at us because of that.”

Smith said the hospital often uses temporary, internship-type positions to allow physicians to practice in the area before making a full-time commitment.

“It lets them try us out and vice versa to see if they’re a fit for the practice and town and to see if they’re comfortable with Natchez,” Smith said. “It’s just as important that they feel comfortable living in Natchez as well as practicing here also.”

Rural areas such as Ferriday are interested in recruiting general practitioners, with a special emphasis on young doctors, Riverland Medical Center Board of Commission President Jim Graves said.

“Because they are young, they can be in the area a long time,” Graves said.

He said many young physicians prefer jobs in large cities instead of rural communities because of the atmosphere and potential for a greater salary. As a result, Riverland Medical Center uses several recruiting techniques to lure recent medical school graduates to the area.

One of their tactics focuses on general practitioners looking to start a private practice.

Graves said Riverland pays the doctor and staff’s salaries for one year, or until the private practice can sustain itself.

The program doesn’t pay for testing equipment, such as X-ray machines.

Graves said Riverland recoups the money through patients coming back for testing.

“We look at it as a long-term investment in our community,” Graves said. “It’s a large investment, and it can be difficult to find the money, but getting the doctor is what matters.”

Riverland also attracts young, general practitioners to the area by paying for medical school debt in return for a specified amount of service, Administrator Billy Rucker said.

Hitting the books

Smith is Riverland’s latest example.

The hospital guaranteed to pay for $100,000 of Smith’s medical school debt in exchange for four years of service, he said.

“As soon as you get out of residency, they ask you to pay your loans back. It’s hard to get out and start paying back immediately,” Smith, who is a Natchez native and graduated from Cathedral High School, said. “I like that there is a good sense of community.

“You can really get to know your patients.”

But he didn’t accept a job at Riverland Medical Center just for the debt relief.

Smith said his familiarity with the area was his primary motivator for returning to the Miss-Lou.

Natchez native and recent University of Mississippi Medical Center School of Medicine graduate Dr. John Browning is also getting paid to return to a rural area after he finishes his residency.

Browning is part of the Mississippi Rural Physicians Scholarship Program (MRPSP), which was created by the Legislature in 2007 and offers students incentives to become primary care physicians in rural areas.

Browning said getting his medical school tuition and debt paid for was icing on the cake for him since he already wanted to become a family physician in rural Mississippi in either Natchez or Yazoo City.

“I told the person I interviewed with that they might be better off giving this money to someone else because they’re paying me to do what I’m already planning on doing,” Browning said. “If you think about it, you don’t know the name of your anesthesiologist, and I didn’t know specialists existed when I was growing up because we all went to the family doctor for everything.

“Family physicians are really community figures that everyone knows.”

Browning is currently working on his residency at UMC in Jackson, where he will work with a family physician at the hospital for the next three years.

“I’m doing everything I would be doing in three years from now, the only difference now is that I go check with my attending (doctor) who oversees me,” he said. “I’ve never been happier in my life and there is no doubt in my mind this is for me.

“I love it.”

Browning said he sees programs such as the MRPSP being crucial to attracting more young doctors to rural areas, but also to increase the number of doctors who practice general medicine.

“Family and general medicine is kind of like the ugly stepchild,” Browning said. “Family doctors work more and get paid less, so a lot of kids are trying to go for those high-paying, specialty jobs.

“But I think we’re continuing to increase the number of family doctors every year through the (MRPSP) program.”

On the hill

Since the MRPSP’s creation, the Legislature has continued to increase funding for the program.

Students who agree to serve in a primary care specialty, such as family medicine, obstetrics and gynecology, pediatrics, medical pediatrics or general internal medicine, in a rural area get $30,000 a year to complete their training.

Rep. Sam Mims (R-McComb), who is chair of the House Health and Human Services Committee, said he and other state officials are continually looking at legislation to increase the number of physicians in Mississippi.

Mims authored a bill in 2012, which Gov. Phil Bryant signed, that established the Office of Mississippi Physician Workforce at UMMC to increase the number of medical residency programs offered throughout the state.

Bryant’s goal is to add 1,000 physicians to the state’s workforce by 2025.

“We see what’s happening in the state and country with the physician shortage, so we’re really trying to be proactive to come up with ways to get people here,” Mims said. “The goal is just to get that person to come to our towns because once they come, I think everything is already there to get them to stay.”

Growing up in an area is often the reason students are interested in practicing in a rural medicine, Director of LSU’s New Orleans School of Medicine’s Rural Health Program Kim Edward Leblanc said.

“Rural students usually go back home,” Leblanc said. “In our program, we try to target rural students because of that interest.”

LSU’s New Orleans School of Medicine has a similar program to Riverland. In exchange for four years of tuition, graduates are required to serve five years in a specific area, Leblanc said.

The rural scholars track started in 2002 and had its first graduate in 2005. A total of 62 students have graduated from the rural scholars track.

The track paid for a maximum of 15 students per year. The latest incoming class only included 11 students, because of budget cuts.

“I wish we could support more students,” he said. “I think our legislators need to step up and help us out a little more. We receive very few state dollars.”

State legislators may already be working to find a solution.

The Louisiana Legislature originally created LSU’s program in 1976. The Legislature provided a way for schools to pay for tuition in exchange for services. The latest amendment was in 2004 by Sen. Francis Thompson (D-Delhi).

But Thompson believes more should be done.

“We need to put a little more meat on the bones,” Thompson said. “We aren’t doing enough to put doctors in rural areas. I know our budgets are strapped for money, but the laws need to be updated.”

Thompson said he plans to focus on creating an updated version of the bill in the 2014 Louisiana legislative session.