Making Further Continuing Appropriations for the Fiscal Year 2007

MAKING FURTHER CONTINUING APPROPRIATIONS FOR THE FISCAL YEAR 2007 -- (Senate - February 14, 2007)

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ACCESS TO HEALTH CARE

Ms. MURKOWSKI. Mr. President, I rise this afternoon to speak of an issue of great concern in my State of Alaska but also a concern we are seeing across the Nation, and this is access to health care and, more specifically, access to the professionals who provide for our very important health care needs.

In just 20 years, 20 percent of the U.S. population will be 65 years or older, a percentage larger than any other time in our Nation's history. And just as this aging population places the highest demand on our health care system, the Council on Graduate Medical Education states that there will be a national shortage of over 100,000 physicians in this country. Other experts look at it from a bit more dire perspective and predict a shortage closer to 200,000 physicians. If that becomes a reality, 84 million patients will be left without a doctor's care.

A dozen States already report physician shortages. Across the country, patients are experiencing, or soon will face, shortages in many physician specialties, including cardiology, radiology, and several pediatric and surgical subspecialties. Demand for doctors is accelerating more rapidly than the supply, and yet the number of our medical school graduates has remained virtually flat for over a quarter of a century.

During that same time period, the median tuition and fees at medical schools have increased by 750 percent in private schools and by nearly 900 percent in public schools.

To add to that, much of the Nation's physician workforce also is graying. They are simply getting older. They are heading for retirement. A third of the Nation's 750,000 active post residency physicians are older than 55 and likely to retire just as this boomer population generation moves into its time of greatest medical need. By the year 2020, physicians are expected to hang up their stethoscopes at a rate nearly 2 1/2 times the retirement rate of today.

A looming doctor shortage threatens to create a national health care crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases. People are waiting for weeks to get appointments, and emergency departments have lines that fall out the door, literally. Many will go without care entirely, and we know the consequence then in terms of the pressures on the health care system when they go without care. In rural America, patients have long gone without care. In fact, the shortage of physicians, especially primary care physicians, in rural areas of the United States represents one of the most intractable health policy problems of the past century. As a result, rural patients are often denied both access to care and quality of care. One-fifth of the U.S. population lives in rural America.

Yet only 9 percent of the Nation's physicians are practicing in these areas. Over 50 million of these rural Americans live in areas that have a shortage of physicians to meet their basic needs.

Additionally, physician recruitment to rural America has also been a problem. The high cost of medical school is in large part to blame. Most students, very severely in debt after medical school, are forced away from primary care and forced into more lucrative speciality medicine. Rural areas and their community health centers across the Nation report a declining ability to recruit primary care physicians.

Alaska, as my colleagues have heard me say on the floor of the Senate many times, geographically is huge. It is a State larger than Texas, California, and Montana combined. In Alaska, ``rural' really takes on a new meaning. The physician shortage crisis in Alaska has long been magnified. Health care delivery in the State is extremely difficult because, in part, there are fewer roads than in any other State. Even Rhode Island has more roads than Alaska. This means that for the vast majority of communities in Alaska, our medical supplies, our patients, and our providers all must travel by air, which adds to the cost.

Alaska's population is growing, especially its elderly population, which is the second fastest growing in the Nation.

People don't typically think of Alaska as having a fair number of seniors, but our senior population is growing at a very rapid rate. However, Alaska's physician workforce, as others across the Nation, is aging. The number of new residents is not keeping up with attrition. Mr. President, 118 physicians in Anchorage alone are expected to retire in the next 10 years.

Currently, Alaska has the sixth lowest ratio of physicians to population in the United States. Outside of Anchorage, the ratio is the worst in the Nation. To put it into perspective, if Alaska were to reach its national average of physicians to population, if we were to reach it by the year 2025, we would need a net increase of 980 physicians statewide or 49 more physicians per year.

For some in States where their population base is significant, they might say 980 physicians between now and 2025 isn't that bad. We only have about 650,000 people in the State of Alaska. For us to find 980 physicians, or 49 more physicians per year, is a tall order.

In Anchorage, many specialties are in serious or in critical shortage, including general internal medicine, neurology, neurosurgery, rheumatology, and infectious diseases. Patients wait for months to be accepted as new patients for general internal medicine. Others have to be flown to Seattle for some critical specialties.

I need to repeat this because we are not just talking about ``I don't like this particular doctor, and I want to find somebody else.' We don't have the physicians to see the patients, so a patient will wait for months for an appointment or the other alternative is to fly outside to Seattle.

There is a bright spot, though, on the horizon. Even though Alaska has only one residency training program--and I should also mention we don't have any medical schools in the State of Alaska--our one residency training program trains 12 family medicine residents each year--clearly a number that is far fewer than our population needs. Seventy-seven percent of the residents choose to stay in Alaska--the highest rate of return in the Nation. We know why it is. We figure we have an awful lot to offer those who come to the State, but the problem is drawing them to the State in the first place.

In the last Congress, with great fanfare, we provided a Medicare prescription drug benefit. But the question I was asking at that time is, What good is a prescription drug benefit if there is no physician to write prescriptions? In the 21st century, we cannot, as a Government, permit such dire access to care to continue. I do believe the situation is intolerable. We cannot sit by while potentially millions of patients go without care. That is why I am proposing a three-pronged plan to alleviate the Nation's rural health care access crisis.

Earlier in the year, I introduced the Rural Physician Relief Act. This is legislation which would provide tax incentives for physicians to practice in our most rural and frontier locations in the country. Today, I am announcing a second step on improving access to health care. Soon, I will introduce the Physician Shortage Elimination Act. This is a strong step in improving access to our health system. Later, as the third prong of my plan, I will introduce comprehensive legislation for improving the plight of the uninsured.

To get to the Physician Shortage Elimination Act, it essentially does four things:

First and foremost, it doubles the funding for the National Health Service Corps. This program has operated with 37 years of excellence, providing primary care services to our most vulnerable populations. It is a solution to the many students who find the exorbitant cost of medical school prohibitively expensive. However, the program is just too small to meet the great need in underserved America. Right now, over 4,000 National Health Service Corps clinicians provide primary care to nearly 6 million people nationwide who otherwise would likely have gone without care. Tragically, this still leaves some 50 million people with extremely diminished access to health care. In fact, the American Association of Medical Colleges said the current program only meets 12 percent of the needs of the underserved. Yet this program is so popular with medical students that 80 percent of its applicants in a typical year must be turned away.

This National Health Service Corps has a proven track record. Let us build on its success. Doubling our investment in the National Health Service Corps is the most prudent, most cost-effective and expeditious way to meet the current needs and future needs of America's underserved. In fact, the former president of the AAMC stated that the National Health Service Corps:

..... is ideally positioned to alleviate the shortage of physicians in many medically underserved areas but has only had sufficient funding to accommodate only a fraction of those young physicians who are prepared to practice in those areas.

The second part of the bill will improve and expand current medical residency programs. Half of all physicians practice medicine within 100 miles of their residency. This means the residents who train in rural or underserved areas are likely to remain in those areas. The small Alaska Family Residency Program, which is a program designed to help meet the needs in rural Alaska, is a great example of this. Of the 55 graduates, 75 percent have stayed in Alaska upon completing their residency--the highest return rate of any graduate medical program in the country. Unfortunately, it is too small to meet the large needs of rural Alaska.

Rural and underserved residency programs must be allowed to flourish. We have arcane barriers, and we have artificial caps on residency programs that need to be removed. Students must be allowed to learn their craft in the most rural and underserved areas of the Nation. My legislation will prevent residency programs from being penalized for training in locations where the need is greatest, such as the Indian Health Service locations. Additionally, it will remove barriers that prevent programs from developing rural training rotations and rural experiences in their curriculum. All the experts agree that this is likely one of the most effective ways to prepare students for a rural practice.

Further, the legislation will reauthorize the Centers of Excellence Program and the Health Careers Opportunity Program. This did not receive funding for 2006, but these are important programs, and they target disadvantaged and minority students from as young as kindergarten on through high school. They target these young people to develop an interest in the health professions. The programs nurture the youth in rural and underserved areas, and they create a pipeline to careers in the health professions. This concept of ``growing your own,' if you will, is the most effective way of achieving long-term retention in most rural locations.

Finally, my legislation will bolster the cornerstone of health care in rural America, which is the community health center. Community health centers provide quality community-based health care for millions of America's medically underserved and uninsured. This bill will help them do their job. It will expand residency programs and primary care services offered by community health service centers and offer grants to health centers to assist them in recruitment, technical assistance, and physician mentoring programs.

Mr. President, as a person coming from a rural area, you know a strong commitment to our community health centers is a smart, cost-effective way of maximizing our health care dollars for our neediest populations.

The prognosis for quality of health care in America right now does not look good. The prognosis is poor. Fifty million Americans in underserved areas across the Nation today already must do without care. Soon, we will have greater problems. We will have even greater physician shortages, which will mean another 84 million patients will be left without a physician's care.

We must act here in Congress. I ask my colleagues to take a look at the legislation we are introducing, the Physician Shortage Elimination Act, and see if this isn't something we can join together to work on so we can continue to provide the level of care Americans across the country, in both rural and urban areas, deserve and expect.

With that, Mr. President, I yield the floor.

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