I got an email from Dale Quinney,  the Executive Director of the Alabama Rural Health Association. He has put together a data set describing the primary care workforce in Alabama (found here). Dale is a data geek, and likes to put data together in interesting ways for folks to use to make value observations. These data demonstrate, among other things, that the primary care workforce in Alabama is old. Of the 3000 odd doctors, not only is the median age 52, but there are about 150 (or about 5%) above the age of SEVENTY. Many of these live in rural areas. Per Dale:

While the median ages are the same (52 years) in 2012 for rural and urban physicians, it is interesting to note that the average or mean ages for rural and urban physicians were higher than the median ages in 2006, emphasizing the older ages in both areas. However, by 2012, the average or mean age for urban physicians (51.4 years) was lower than the median age (52 years), emphasizing the younger ages among urban physicians.
So as with our highways, our schools, our libraries, and other non-sexy stuff, years of inattention have lead us to a primary care infrastructure crisis. For those towns with one (or several) doctors over 70 this  inattention puts all of their citizens at risk of premature death. Dr Starfield offered advice for folks in our situation. She said
At the very least, they can initiate policies to target state funding of medical teaching programs to institutions focusing on primary care training and provide greater financial support (as through loan forgiveness) to physicians who specialize in primary care. They also can encourage or mandate lower payments to specialists for patient visits NOT made by referral from a primary care practitioner. Additionally, they can increase reimbursement rates to providers who demonstrate that they deliver primary care in ways to achieve its benefits; instruments are available to document the primary care orientation of practices.
You listening, Governor Bentley?
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