Attracting Physicians to Underserved Communities Is Not the Solution to Providing Better Access to Underserved Communities

By Nurkin, Harry A. | Frontiers of Health Services Management, Winter 1998 | Go to article overview

Attracting Physicians to Underserved Communities Is Not the Solution to Providing Better Access to Underserved Communities


Nurkin, Harry A., Frontiers of Health Services Management


Thomas P. Weil's "Attracting Physicians to Underserved Communities: The Role of Health Networks" suffers from a lack of focus, a lack of definition of the problems and participants, and a lack of documentation to support either the author's premises or conclusions. Unfortunately, Weil falls victim to the age-old phobia of trying to draw attention to a specific problem by describing anything and everything as either a causative agent or a confounding variable. The result is an accumulation of some related and some unrelated issues that are, at best, confusing.

More distressing than the confusing lack of focus is the author's repeated use of inaccurate, inappropriate, and worn-out categorizations. The reader is left wondering whether the author is truly interested in the recruitment of physicians to underserved communities or simply flailing away at the suspected sociopolitical causes of poverty in America.

For example, the world that I live in is not simply divided into affluent urban and suburban communities and poor rural and inner-city communities. In fact, people who live in the "inner city" face different problems of access to medical care than those who live in rural settings. The same can be said for people who live in urban versus suburban environments, regardless of their economic status.

Another problem with Weil's thesis is that if Weil can actually accumulate 73 million... uninsured and seriously underinsured Americans, I doubt "seriously" that either Weil, or those he quotes, really expect us to believe that: (1) all of these people cannot obtain any form of basic health coverage; (2) all 73 million of these people live in poor rural and inner-city environments; (3) the lack of health coverage for this group is caused by a geographic maldistribution of physicians in America; and (4) the health coverage of this group will be enhanced by recruiting physicians and somehow paying the physicians 30 percent more than average, providing a "collegial" work environment, or both.

Descriptors such as "affluent" and "poor," "suburban" and "inner city" separate, segregate, and categorize human beings in negative ways, without defining the maldistribution problem.

The way Weil uses these terms in an attempt to define his thesis implies that physicians and other institutional healthcare providers are somehow guilty of causing the problems that underinsured people experience, simply by where physicians practice medicine or where hospitals were constructed 20 to 50 years ago.

Weil focuses on several approaches that health networks might use to increase their market penetration. Health networks is an amorphous term that has no real definition, and I am unaware of any health executive who believes that capturing the "uninsured" to increase market share is a viable concept for health networks. However, I wonder why health networks are mentioned to the exclusion of local and state public health departments; local, county, state and federal government programs; and social service agencies that deal with the elderly, children, unwed mothers, substance abuses, and so forth. Most Americans cannot identify a health network because most Americans are provided health services by private, public, and governmental agencies and providers that are not part of a health network. Health network is the current buzzword, but it is certainly not descriptive of the organizations and people who provide health services to the American people.

Weil offered specific recommendations for health networks that attempt to solve the maldistribution crisis. Each recommendation is enumerated below, followed by my interpretation. According to Weil, health networks should:

1. Provide eminent leadership in the overall design and governance of soundly conceived Medicaid HMOs. …

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