New Bern, NC – INTRO - A "white paper" recently issued by the Brody School of Medicine at East Carolina University gives an overview of the health status and needs of eastern North Carolina. George Olsen has more.
Federal health care reform has been a major topic of discussion years of debate followed by President Obama's signing into law in March the Patient Protection and Affordable Care Act. Despite the years-long debate the end result of the legislation will be is still to be determined.
"There's evidence that primary care which is an area we emphasize at our school is going to be supported in ways they've not seen in the past, but we'll actually see likely an increase in the number of patients who don't have what we consider "Cadillac level" insurance plans, so they may have insurance but it will barely pay for their costs and they will be at higher volume and frequency, so we're not sure overall that its going to turn out to be a windfall by any means."
Dr. Paul Cunningham, the dean at the Brody School of Medicine at East Carolina University and one of the authors of the report. If primary care does become an area of emphasis, that could be a boost for health outcomes in eastern North Carolina which Dr. Cunningham says trail to health outcomes in the rest of the state.
"Diabetes mortality rate is probably the worst in comparison to the rest of the state and its 35% greater and continues to get worse. We have 12% more deaths from stroke than the rest of the state. The region's death rate from cancer and heart disease is about 10 % greater than the rest of the state."
Those numbers likely haven't improved with the recent recession, with Dr. Cunningham saying there's been evidence of more indigent patients receiving care. Dr. Cunningham says Brody School of Medicine physicians provided $10 million worth of free care last calendar year, a figure he refers to as "not sustainable" for the school.
"If we spend money on our emergency department we don't have additional funds available to do preventative services or deal with issues that may need to be addressed in a more longitudinal or chronic manner. If we're only dealing with acute problems, we have no real means to spend time in the public schools or in the public health arena, so, yes, it is inimical to get ahead of the issue if we're only just putting out fires on a regular basis."
Toward that end, the Brody School of Medicine received $2 million from the state Legislature last year toward covering that care. This year they plan to ask for an additional $3 million. In a tight budget year, getting extra funds will be problematic also making a Brody School of Medicine goal to train more doctors problematic as well. The current class size is 78. The white paper would like to see the school training 120 doctors something considered crucial to the health of the area as the paper reports 19 counties had fewer physicians per 100,000 people in 2008 than five years earlier. The school has done a good job so far of getting the doctors they train to stay 59% of graduates practice in the state. At such a time when budgets aren't lean and investments can be made in school expansion, Dr. Cunningham hopes to keep even more doctors in the state through a series of satellite training centers for 3rd and 4th year students.
"For the last two years they would be in a community, they would live in the community and would not come back to Greenville unless there are exceptional reasons. We felt that this would be a good strategy for communities to recruit their doctors. If you embed doctors in communities over time they'll literally develop a relationship with that community and I think that's one method of us helping our rural environment to retain physicians in those areas."
And getting those physicians into those underserved areas would move eastern North Carolina toward a long view of health care rather than a system focused primarily on immediate needs.
"My background is I was born in Jamaica which is called an emerging country. Many of the issues we see in eastern North Carolina are duplicated in a country with vastly less resources than we currently have in the U-S. We do provide in this country the best acute care services in the world. However, we feel we do need to go one step beyond that and so that we can provide not just highly effective acute care service but the sort of service that will prolong life."
Dr. Paul Cunningham is the dean at the Brody School of Medicine at East Carolina University. I'm George Olsen.