This past week I was interested in a front-page article in our local paper-Rural healthcare lags behind. What does that mean and how does the Affordable Care Act (ACA) affect areas like the Eastern Shore of Maryland as well as other rural areas of this State and around the country?

There are other areas in similar to the Eastern Shore of Maryland where the rural population consists of a large Medicare and Medicaid patient population needing health care.

Isn’t this why ACA was designed? The article describes these areas as challenges of providing health care where the patients are very sick and the resources, which are very scarce. These areas are lacking health care providers contributing to health disparities that include higher rates of heart disease and obesity and lower life expectancy. The author, Megan Brockett, compares the situation is akin to a “Third World country.”

Maryland is especially problematic in that in the national 2014 County Health Rankings released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, found that five of the 10 least healthy jurisdictions in Maryland are considered partially or completely rural by federal standards and three others in the bottom 10 fall under the state’s broader definition of rural. The article further points to the lower rankings in health care outcomes.

The experts and advocates link the disparities to the scarcity of health care providers in these rural areas and the decreased access to care. The ratio of primary care providers to residents is horrible from a best-case scenario of 1 in 1,056 – to the worst case of 1 to 2,915.

“As a result, people living in rural areas often have to travel long distances for health care, a disincentive to getting even the basic preventative care they should be receiving.” Now add the additional burden of high deductibles, where the patient has a higher out of pocket expense in their health care.

Ms. Brockett goes on to point out that the rate of specialty care providers is worse in the rural areas through out the state. And the effects are seen regularly in the clinics around the state.

Much of the campaign to improve the situation centers on efforts to recruit and retain health care providers to practice in these rural communities and the workforce shortage in rural areas is the biggest barrier to care.

This article is so interesting to me, a specialist practitioner, who practices in one of the state’s rural areas. I have had my billing agency beg me to move my practice out of the rural area to increase my reimbursements by 17-20 %. This is true in a state, which is so backward in that they have demographic areas that pay the physicians at a lower rate than a county/ areas 30 to 45 minutes away. Why would any new physician graduating with a debt in loans of on average of $325, 000 want to practice here where they may never be able to pay back their debts?

Do we get a break in malpractice premiums or practice overhead in the rural areas? No and No.

So, why would any new practitioner want to come to one of the rural areas in Maryland or in any rural area in the US?

Nothing will change regarding the practitioner to patient ratio to acre for the additional enrollees until the educational costs and tort reform is reality.

Another article appeared in The Week magazine, April25, 2014, Page 12 by Daniela Drake-Why doctors are so unhappy. It is a summary of her review in The Daily Beast, starting with the quote “Being a doctor has become a miserable and humiliating under taking.” She states something those of us who went into medicine 20-30 years ago, that “caring for the sick used to be the country’s most prestigious and admired professions.” However, today an emotion that I feel almost daily, that America has declared war on physicians and yes I continuously attempt to discourage others from entering the practice of medicine.

Not only primary care physicians, but also all physicians toil thanklessly in a hectic, unsatisfying profession, which is dominated by the insurers, politicians and their agencies, and malpractice attorneys. We physicians work long hours cramming in more patients than reasonable, 20-30 per day because of regulated fees and the cost of filling out insurance forms, which averages $58 per patient. Right now without all the added enrollees secondary to the ACA the average patient visit lasts 12 minutes. What information, what type of diagnosis can be made in that short period of time?

It is amazing to me that no one challenges the “salaries” that actors or professional athletes make, however they try to make doctors feel guilty when they make money. Do you think that it costs nothing to run a practice with electronic medical records. computers, specialized staff of nurses, billing personnel, etc.?

Patients question and try to make doctors feel guilty about changing their practices to boutique or concierge type of practices. However, more and more physicians will need to convert their practices to this type of practice as the government further discounts physician’s reimbursements and deductibles rise or face bankruptcy or early retirement.

Affordable health care will add more bureaucracy and pressure to cut costs and make it more expensive to maintain their practices. Health care providers, doctors, nurses, nurse practitioners, physicians and the hospitals will be losers in the future of the new system. Who are the other losers? I will delve deeper in the “losers” of ACA or Obamacare. Can you think who will be the “Biggest Losers?”

Doesn’t anybody care except the perceived “rich” doctors?

Again I say, wake up America! We need to have a system that understands what it takes to have a truly affordable health care system that is sustainable and fair to all.