Scheduling a doctor’s appointment can be difficult and time-consuming no matter where you live. Especially if you live in a place that doesn’t even have a doctor.
That’s just the reality in nine of Georgia’s 159 counties. But there’s more:
- In 18 counties, there is no family medicine physician.
- In 40 counties – one-quarter of the total – there is no internal medicine physician.
- In 65 counties – more than a third – there is no pediatrician.
- In 82 counties – more than half – there is no OB-GYN.
- In 90 counties, there is no psychiatrist.
These are sobering statistics, and they have been getting worse over time.
There has been much news coverage of hospitals closing in areas both rural and, with the planned shuttering of the Atlanta Medical Center in a matter of weeks, urban. But while hospital closures harm their communities, the focus on them tends to distract us from the fact that nine counties, home to almost 51,000 residents, have no doctors whatsoever.
Add the counties with only one doctor, and 1 in 10 Georgians live in a county with no more than a single physician.
There can be shortages even in those places where doctors are numerous. The state’s most populous county, Fulton, has more than 5,400 doctors, yet it has pockets that are considered “primary care health professional shortage areas.” Only 10 counties in Georgia don’t have any such areas.
What can be done? The usual suspect, Medicaid expansion, doesn’t offer much hope. You can’t use insurance of any kind at a non-existent doctor’s office. And the program’s low reimbursement rates mean expansion is unlikely to attract new physicians to places without a practice today.
Maybe the answer doesn’t entail having a doctor at all.
Mid-level healthcare professionals, from physician assistants (PAs) to various types of advanced practice registered nurses (APRNs), offer these communities a more realistic chance of increased access to care. If only the state government would get out of their way.
Georgia law prohibits PAs and APRNs – which include nurse practitioners, certified nurse-midwives, clinical nurse specialists and certified registered nurse anesthetists – from performing the entire scope of practice for which they are trained. Our laws also require more supervision by a physician than many other states require.
Simply by allowing these mid-level practitioners to perform work to the full extent of their training, we could expect to significantly increase the health services available to Georgians. We could also anticipate an increase in the number of these professionals. For example, the share of rural primary care practices with a nurse practitioner on staff rose nationally by 10 percentage points between 2008 and 2016, as more states granted full practice authority to those professionals. It’s worth noting that these certifications require less time and expense than the medical training needed to become a doctor.
A recent report by the Georgia Public Policy Foundation noted that 26 states already allow full practice authority for nurse practitioners in particular. North Dakota and Utah have also taken steps in recent years to allow greater practice authority for physician assistants.
In particular, Georgia could expect to see improvements in both mental health and maternal health by expanding practice authority. Georgia is among the lowest-ranked states in both categories, in large part because half of our counties lack psychiatrists and OB-GYNs, respectively. Nurse practitioners and certified nurse-midwives could help address these shortages if allowed.
We could also expect economic benefits. If underserved areas could gain more access to care, employers would be more likely to locate or expand operations there. PAs and APRNs with full practice authority would also be more likely to open their own clinics, boosting employment in those communities directly.
In an ideal world, there would be plenty of doctors for every community. But our world is less than ideal in this regard, and trending in the wrong direction. Letting our medical professionals do more to fill the gap is an obvious step in the right direction.