We want all people to be in good health and have access to the health care services they need. But many Georgians are struggling to afford health care, causing them to put their well-being at risk by delaying care or leaving them with medical debt. And some people are not able to find health services in their area due to a lack of providers.
State leaders are pursuing policies that could drastically reform health care in Georgia and one of these solutions is to address health care workforce shortages across the state. These shortages remain in many areas, especially in rural communities and underserved urban and suburban neighborhoods. Georgia ranked 48 among states for the availability of mental health providers, according to Mental Health America’s 2019 report. There are eight Georgia counties without a physician, 63 counties without a pediatrician, 75 counties without an OB/GYN and 95 counties without a psychiatrist, according to the latest available data from the Georgia Board for Physician Workforce.
Georgia made strides in recent years to improve provider capacity, including increasing new residency slots and allowing certain providers to perform services with fewer restrictions. The state continued this work through several bills and budget items I will highlight below.
Highlights from the 2019 Session Related to Health Provider Workforce Issues
The Georgia Board for Physician Workforce is central to the state’s work on provider capacity issues. The Board collects data on the number and geographic location of available physicians. It also oversees state medical education funding and offers a loan repayment program for physicians, dentists, physician assistants and advanced practice registered nurses in rural counties. Over the past several years, it expanded its research and programs to include different types of health care professionals. This year, Georgia lawmakers passed legislation (SB 207) to change the name of the Board to the Georgia Board of Health Care Workforce and revise the board membership by appointing a dentist, physician assistant and nurse practitioner. This is a positive step toward the state working to address workforce shortages within other critical health professions. The Board’s FY 2020 budget includes notable additions such as:
- $5.5 million for Morehouse School of Medicine, including $5 million to replace lost federal matching funds for graduate medical education and $500,000 to establish a Center of Excellence on Maternal Mortality
- $1.9 million to fund 139 new primary care residency slots to allow more medical graduates to pursue in-state training
- $828,042 for 54 OB/GYN residency program slots. These slots will increase the total to 36 slots at Emory University School of Medicine, 20 at Medical College of Georgia, 16 at Memorial University Medical Center, 16 at Morehouse School of Medicine and 16 at Navicent Health Care Macon
- $500,000 to increase funds for the rural loan repayment program. In FY 2018, there were 95 recipients practicing at least 40 clinical hours per week across 62 different counties with populations of 50,000 or less
- $500,000 for Augusta University to plan a new initiative shortening medical school to three years for a class of up to 50 students and placing them in three-year primary care residencies. The students pay no tuition if they agree to serve in an underserved area of the state for six years.
Georgia leaders also made progress by passing legislation to address workforce needs and the challenges providers may face when seeking to practice in the state. Some of these highlights from this year include:
- Creating the Georgia Behavioral Health Reform and Innovation Commission (HB 514). The commission will conduct a full review of the state’s behavioral health system, including workforce shortages. One of the five subcommittees will focus on workforce and system development.
- Expanding the use of telemedicine as another strategy to respond to health care workforce shortages. SB 115 allows out-of-state physicians to apply to be licensed telehealth providers in Georgia. SB 118 reforms and updates Georgia’s telemedicine act, including requiring payment parity to cover telehealth services at least at the rate for the same in-person service.
- Authorizing the Georgia Composite Medical Board to administer the Interstate Medical Licensure Compact (SB 16), which is an expedited way for physicians to get licensed in multiple states.
- An income tax credit for physicians, advanced practice registered nurses and physician assistants who provided unpaid preceptorship training to students in the profession (HB 287). The new tax credit is expected to provide a greater incentive for providers to become preceptors compared to a tax deduction that was previously offered.
- $150,000 added to the Department of Public Health’s FY 2020 budget for a nurse peer assistance program. The program will help pay certified peer support specialists, who will provide support services for nurses recovering from substance abuse. These peer specialists have personal experience with mental illness or substance use disorder. Georgia is a leader in the peer specialist certification and reimbursement model, which is a strategy to boost the mental health workforce.
Looking Ahead on How Georgia Can Build on Its Health Workforce Efforts
The state’s efforts to increase the number of health care workers with advanced degrees in underserved areas are important. And the state has succeeded in expanding its scope from focusing on doctor shortages to also include nurses, dentists, and physician assistants. But there is also an important role for the state in boosting the number of middle-skill health care workers. These are positions that require some postsecondary education but do not require a four-year degree. This includes workers such as licensed practical nurses, dental hygienists, medical assistants, health care coordinators and community health workers. GBPI’s People Powered Prosperity initiative highlights the gap in middle-skill jobs and promising solutions.
Access to health care was a major topic of discussion in this year’s legislative session. Building a stronger health workforce can help to improve access to health care. But another important aspect of accessing health care is being able to afford the services. While Georgia has made progress on provider capacity solutions, the state has not taken many significant steps to increase health care coverage. Health care coverage is the foundation that people need in order to afford health services. Having fewer uninsured residents is better for hospitals’ bottom lines and can allow them to hire more workers. To improve access to care, Georgia should prioritize extending coverage alongside efforts to boost the availability of health care providers.