{"id":11783,"date":"2012-10-09T11:58:13","date_gmt":"2012-10-09T17:58:13","guid":{"rendered":"http:\/\/stateimpact.npr.org\/idaho\/?p=11783"},"modified":"2012-10-09T12:29:36","modified_gmt":"2012-10-09T18:29:36","slug":"an-interview-with-dr-ted-epperly-on-idahos-doctor-shortage","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/idaho\/2012\/10\/09\/an-interview-with-dr-ted-epperly-on-idahos-doctor-shortage\/","title":{"rendered":"An Interview With Dr. Ted Epperly On Idaho’s Doctor Shortage"},"content":{"rendered":"
\"\"<\/a>

Emilie Ritter Saunders \/ StateImpact<\/p>

Dr. Ted Epperly is the director and CEO of the Family Medicine Residency of Idaho based in Boise. Epperly wants to see state support increase for med school and residency programs in Idaho.<\/p><\/div>\n

Dr. Ted Epperly\u00a0<\/strong>is CEO of the Boise-based Family Medicine Residency of Idaho, a program that gives medical students their last three years of training before they become doctors.\u00a0 He was an Army physician for 21 years before returning to work in his native Idaho.\u00a0 In addition to managing the residency program, Epperly is active in state and national health policy.\u00a0 <\/em><\/p>\n

StateImpact<\/em>\u00a0Idaho<\/em> spoke with him recently for our series on Idaho’s doctor shortage<\/a>.\u00a0 The state currently has a lower number of doctors per capita than every state in the nation except Mississippi.<\/p>\n

We wanted to include more from our interview with Epperly, so here is a portion that has been edited and shortened.<\/p>\n

Q: <\/span>How has medical care in Idaho changed because of the shortage of doctors?<\/p>\n

A: <\/span>What it does is slows down the ability to get appointments in a timely way, and then when you do get the appointment it\u2019s usually for less time.\u00a0 That\u2019s a problem with our fee-for-service, volume-driven system.<\/p>\n

Part of what\u2019s happened in health care reform is this idea of health care through an expanded medical home.\u00a0 Which means the expanded team of a practice cares for people in the community in a proactive way — to keep them healthier, so they aren’t coming into a clinic as often. <\/strong>We could start to affect the volume of patients that needs to be seen.\u00a0 The payment systems have to start paying for those services so physicians can provide them.\u00a0 Right now, you don\u2019t get paid to do that \u2013 so you have to wait until people get sick before they come into your clinic.\u00a0 It\u2019s just backwards.<\/p>\n

Q: <\/span>The U.S. Supreme Court ruling on the federal health law leaves states to decide whether they want to expand Medicaid, the state health plan for low-income people. How does a possible\u00a0Medicaid expansion in Idaho complicate things?<\/p>\n

A: <\/span>First, I think it\u2019s really important we do expand Medicaid<\/a> in this state, so all people that qualify can have access.\u00a0 That way, at least they have coverage so it doesn\u2019t become a barrier to them seeking care.\u00a0 The practicality of that though, is we don\u2019t have enough primary care doctors in the state to easily absorb that.<\/p>\n

I did a rough calculation of the 100,000 or so new patients that will be added to the system.\u00a0 That means about 40 to 50 new patients to every primary care physician in the state. That will present a timely access issue.\u00a0 But that underscores the real issue we have, and that is not having enough primary care physicians.<\/p>\n

Our problem will be exacerbated for a while until we start to train up our workforce.\u00a0 We also need to expand the use of physician assistants and nurse practitioners to augment the health care teams.\u00a0 Family doctors working in conjunction with physician assistants and nurse practitioners should be what we expect.<\/p>\n

We have to think more collaboratively of how we work with people. And then we have to have a priority of training more primary care physicians for our communities.\u00a0 Again, if we start taking care of problems in a more timely fashion, keeping people well instead of waiting until they get sick, then downstream we\u2019ll save a lot of money in unnecessary emergency room visits, unnecessary hospitalizations.\u00a0 ER\u2019s are not a default \u2013 it\u2019s not where people should be for common problems.<\/p>\n

Q:<\/span> More than half of the residents in your program stay in Idaho. But why do so many other doctors chose to leave?<\/p>\n

\u00a0A: <\/span>I really admire our family doctors who want to tackle family practice, it\u2019s hard work.\u00a0 There are no short work weeks, and you pretty much need to be available to the community almost all the time.\u00a0 So it\u2019s hard to find the types of people who are totally dedicated to those communities in a way that would give up so much of themselves.\u00a0 It\u2019s a sacrifice.<\/p>\n

One thing we found in recruiting and retention in these communities is it’s not so much the physician \u2013\u00a0 the physician typically loves that kind of work.\u00a0 One of the biggest drawbacks is their spouse.\u00a0 If you\u2019ve got a spouse from Chicago and you\u2019re taking them to Salmon, Idaho \u2013 good luck.\u00a0 If that spouse comes from a small rural community, the likelihood of them going there is greatly enhanced and the likelihood of them staying is unbelievably enhanced.<\/p>\n

The other factor that goes into retention is having a group of practice partners you like.\u00a0 If you\u2019ve got a good team to work with, that\u2019s fun.\u00a0 If you don\u2019t or if you\u2019re on your own, that\u2019s a real turnoff.<\/p>\n

Another thing that needs to be remembered is the quality of the education program in the communities. If mom or dad feel the kids aren’t getting a good education in these rural communities, then they\u2019ll leave.<\/p>\n

So, Idaho can\u2019t lose the fact of the importance of K-12 education in all of Idaho.\u00a0 We can\u2019t retain a workforce in rural Idaho if we don\u2019t have a good education system to keep them there.\u00a0 The same for small businesses \u2013 the small business community has to be right to keep a physician in practice.<\/p>\n

There has to be a lot of things going right in a community to keep a doctor \u2013 if any of those things aren\u2019t going right, it\u2019s tough for a community to keep a physician.\u00a0 And then if you don\u2019t have health care in a community you can\u2019t attract business, or teachers.\u00a0 Health care, business and education are all interrelated.<\/p>\n

Q: <\/span>What about the cost of practicing in a small community?<\/p>\n

A: <\/span>Usually, it\u2019s a sacrifice.\u00a0 You\u2019re going to make less in a small community. The average income of a doctor in a smaller community can be as much as 30 percent less.<\/p>\n

The scope of practice, though, tends to be better.\u00a0 You get to use all the skills you\u2019ve been trained to do.\u00a0 From delivering babies, taking care of sick infants, older adults, a lot of end-of-life issues \u2013 and everything in between. \u00a0Many doctors love that large scope.\u00a0 What happens in the bigger communities \u2013 quality of life might be better, but scope of practice is much narrower.<\/p>\n

Q: <\/span>What could be done to entice people to stay, or to come here to practice?<\/p>\n

A: <\/span>A couple of things.\u00a0 The biggest would be the type of education programs we put in the state.\u00a0 Idaho must see, a bigger investment in education, both\u00a0at the medical student level and resident level.\u00a0 It’s an investment the state needs to make.\u00a0 And what I mean by that is having a medical school that\u2019s providing a good number of students coming out of medical school \u2013 that could be in partnership with the University of Washington or other area schools.\u00a0 But before that\u2019s even in place, we have to have more residency programs.<\/p>\n

What happens after medical school is doctors go to three to five years of training.\u00a0 We need multiple residencies in Idaho \u2013\u00a0not just in family medicine, but in general internal medicine, psychiatry, pediatrics and general surgery.\u00a0That way, we become an importer of young physicians in training, we then train them in the state and the likelihood is they stay in the state.\u00a0 If it\u2019s just a medical school model we become a net exporter of medical students to other states that have residency programs.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Ted Epperly\u00a0is CEO of the Boise-based Family Medicine Residency of Idaho, a program that gives medical students their last three years of training before they become doctors.\u00a0 He was an Army physician for 21 years before returning to work in his native Idaho.\u00a0 In addition to managing the residency program, Epperly is active in […]<\/p>\n","protected":false},"author":40,"featured_media":11475,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[13],"tags":[183,188],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/11783"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/users\/40"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/comments?post=11783"}],"version-history":[{"count":1,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/11783\/revisions"}],"predecessor-version":[{"id":11852,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/11783\/revisions\/11852"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media\/11475"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media?parent=11783"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/categories?post=11783"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/tags?post=11783"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}