Linda Benedict | 8/23/2007 3:00:27 AM
J. Matthew Fannin and James N. BarnesWhile Louisiana faces a short-term healthcare crisis brought about by hurricanes Katrina and Rita, an often-understated longterm healthcare crisis exists in rural Louisiana. According to the Louisiana Department of Health and Hospitals, 49 of Louisiana’s 64 parishes are classified as geographic shortage areas for primary care physicians. These parishes, disproportionately in rural areas, typically have only one family practice, general practice, internal medicine, pediatric or OB-GYN physician for each 3,000 or more residents (Figure 1).
No one arrangement type is best for a specific hospital. In some cases, the community must be flexible in negotiating these contracts based on the risk tolerance of the prospective physician. In other cases, the hospital must evaluate its own risks in developing contractual terms with a physician. A rural hospital with a high debt load from investments in buildings and equipment can’t afford to have a downturn in the number of hospital beds that are filled over the long term. Without the proper contractual arrangements with physicians, rural hospitals may lose patients to local physicians who admit a larger proportion of patients to regional hospitals in urban areas.
Rural physician recruitment is a national healthcare problem and has been for many years. While several factors are well understood that affect successful recruitment of physicians to rural areas, we know little about the economic incentives hospitals use to recruit physicians in the United States and certainly in Louisiana. In the past decade, a number of federal programs have provided rural hospitals financial support, which often has been used to strengthen recruitment incentives. These include the Critical Access Hospital and the Federally Qualified Health Center programs.
Future research by AgCenter faculty will focus on how changing federal policies such as these will affect the contractual arrangements used by hospitals when recruiting physicians to rural areas and the type of contractual arrangements hospitals use in persistent poverty areas of rural Louisiana. Perhaps hospitals in these areas could use an alternative contractual arrangement to improve recruitment. Such a step bodes well for providing access to health care services in rural areas of Louisiana.
J. Matthew Fannin, Assistant Professor, Department of Agricultural Economics & Agribusiness, LSU AgCenter, Baton Rouge, La.; James N. Barnes, Director and Assistant Professor, Delta Rural Development Center, Oak Grove, La., and Department of Agricultural Economics & Agribusiness, LSU AgCenter, Baton Rouge, La.
(This article was published in the summer 2007 issue of Louisiana Agriculture.)