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Low Medicare pay adds to rural physicians' burden

But fixing geographic disparities in reimbursement could pit rural doctors against their urban counterparts.

By Markian Hawryluk, amednews staff. March 11, 2002.

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Washington -- Gerald Luckey, MD, does not take a lunch hour anymore. As the physician shortage in the rural area of Nebraska in which he practices worsened, Dr. Luckey started working longer hours and skipping midday meals to see as many patients as possible.

The forces at play in Dr. Luckey's situation are not unique. Many rural communities face a dearth of physicians.

These areas have trouble recruiting doctors in part because of the scarcity of sophisticated facilities and specialists that can ease the load on primary care physicians. But there is another major reason -- physicians in rural areas are paid less by Medicare than doctors in other parts of the country.

"If you can't make it in rural areas of the country, then you go to a place where you can," said Dr. Luckey, a David City family physician. "There are a lot of other incentives with the large areas. You add this disincentive on [rural areas], it definitely will have an impact on care."

Now lawmakers and rural health practitioners are warning of an access crisis stemming from the disparity in payments. With fewer doctors willing to work in rural areas for lower pay, Medicare beneficiaries must wait longer and travel further to get the care they need.

Although there is interest in raising payment levels for these physicians, there are also substantial political hurdles. In a year in which lawmakers are looking to limit the growth of Medicare spending, rural physicians have found they are competing with other doctors for a limited pool of funds. [...]