Pennsylvania is seems a ranks high percentage of physicians citywide but imminently the retention rate from new for young physicians not doing so well joining us to talk about a doctor Bruce -- who's the president of the Pennsylvania medical society doctor good morning. Good morning thanks for -- there. He tell us a little bit about this a physician workforce our report they came out of the association of the American medical colleges I guess. We had a lot of talk about Pennsylvania. And whether or not so we're able to keep. Doctors here are aware how are we doing. Well first of all we have to recognize that that Pennsylvania is one of the the largest training ground for positions in the entire country so that's on the positive side. On the downside a lot of business students who come here trained and the residents who come here train and deploy to other parts of the country. -- we brought this forward just say that we need to work on trying to make Pennsylvania more attractive work environment because. We're looking at a potential shortage here with the the number of people there are now have insurance under the Affordable Care Act. And so we just wonder praises says an issue. Haven't we found out why it is that there are leaving here. Well one of the things is that it's the there's young folks are moving out of the Art Bell this is happy not just in Madison if you look at that many populations there's. I transition of our population into the Sunbelt from blood was traditional populations that are so. Even add that that what that does is at least the aging population then Pennsylvania has one of the older population in the entire country were what the -- the six. -- most populous state but still we have an aging population so in summary our young folk are still moving away and this applies to physicians as well. So I'm I guess -- per capita you know physicians to. Population I guess we're in pretty decent shape. But again and then the whole idea is trying to keep the new doctors stay here and I guess there's got to be some incentives that to go along with that Lowell what can the you know in this day what do. Early due to try to keep them here army and we can't make it's funny year here -- I hit the Sunbelt have what we do to make them one stick around I mean most people I know who do leave. Come back eventually because family is here but you know I don't know that we'll continue. That's good point about Finley is a big draw. I'm calling in from Pittsburgh and third you know whenever we are recruiting for this area hating family. It is very important one of the strategy that has worked in the past is a loan forgiveness. For position to -- unfortunately. Medical schools very expensive and many of the students come out -- is. Are -- over the 200000 dollars so -- loan forgiveness and encouraging the these talented physicians to setup their practice certain rural areas where there's not enough primary care physicians is a strategy that's been put forward as part as the governor healthy Pennsylvania plant. -- were very supportive we see a bit. Really a chance to kind of be if you will kill two birds who wants to -- meeting to keep some young folks. Here in the states and also to address the Mal distribution of positions in that there's not enough doctors in the rural area. How do you do a loan forgiveness program highly so what you're saying is you do loan forgiveness but I would say they'd have to stay here as they're getting their loan forgiven is that what it would be. Right and they -- typically it's five years or how we're different we're not going to consider this so I was doing this is well. I'll be if you forgive their lows for five years they setup shop in a rural area or underserved area which. -- there's also so underserved areas enough Philadelphia's wealth to it and other cities as well not just in the world whereas. Stay fab shop and stay there for five years -- their -- to our forgiveness to -- -- to a certain extent in large parking lot all the way. Now what happens is that a good portion of the physician sent out. Set up shop there you know pick this title like -- I think there's very to have children. They actually begin -- have their family there and so. 50% are over 50% at some of the program then that's stayed in those areas rather than going back to another area and that's a pretty good return on your investment if you can. I'll get his positions to rural areas and underserved areas. The earning potential life I would guess for a darker in rural setting them on another underserved the setting would probably not be as great as it might be elsewhere but. That's a big load off your back and big bill you don't have to worry about paying so maybe that's a that's a pretty fair trade off I -- Edited at each a lot of folks that up in the rural area it's a lifestyle that -- -- you're choosing now are typical -- most rural areas aren't as expensive so you're burning car doesn't have to be as much and if you don't have the burden of this 250000. Dollars debt. -- facing you when you're starting now that your life here started out your family. You can -- maybe then choose an area and even especially that may not be as lucrative but also. Well nobody no love. Not all doctors -- matter of fact I would say most. Medical student -- unaudited for the money. -- -- that there were you know you're able to make a decent living as a physician. Many of them are looking for that relationship with their patients and number. I'm actually confront long term relationship with your patience and a primary first -- it's going to be very attractive editor rural environment. You they can be very intimate you can know the other world environment and underserved very a lot of -- -- -- living in the community where your patients live. And that can be a very rich experience for position. What are the other things I noticed in this report you talk about the number of female of physicians I know that. Where at like number two when he. Compared to others say say a third of our physicians are female but we are expecting that to the number to go higher because. We're seeing more women coming out of -- med school right. Yeah thank goodness I think that there were -- -- tension change in the physician workforce over this generation arm. It could happen that medical students now are women and so as they hit the workforce you're gonna see more women there and women you know a lot of times. Forsaken mr. training and then they wanna have a family so that's sort of effect that a number of physicians are available -- for a period of time while they have a camp because it's because it really is a big challenge for women to. -- have a family and to actually I practiced medicine it's doable and it's we're facing -- many of many physician practices both large -- -- to find out ways to -- family friendly so that you can have a family and continued its position. We have they commonwealth medical college here in Scranton that just began a few years ago but. I'm I'm guessing when you have something like that in your backyard it also helps to bring in people and then hopefully if they like the area they'll stick around as well. That's searchers turned out there where you do your residency maybe the most. For medical training you do medical school which is four years after college and then there's a residency which -- special motivation. What you do your residency typically in large part determine where you practice. There are many folks there where they trained in the practice -- and let's -- go for famous somewhere so. I'll be happy to medical school there as having some residency slots are also important that's another. Proposal is that we have actually from primary care residency slots. There are Pennsylvania that are from the federal government so we can use those to address -- lack of primary care physicians in the -- -- think -- The Affordable Care Act obviously a lot of people have been talking about that. -- looking at the numbers are you concerned. Do you think that's with the new people on the roles were going to have. Trouble there are people who worry that perhaps people won't be able to get into the doctor quickly if there are more people in the pool what are your thoughts on that. I think it's that we're not we don't have a lot of physicians or health clinics sitting around empty right now so as these people. Suddenly and it's supposed to happen over you know the next few months is that these uninsured. Are going to be kidding me insurance and then they will seek access I'll work that they're gonna we're graphic element to assist the worst -- not distract can adapt to them. I think that there aren't confident that this system is large and often complex enough that we're going to be able to find a way to absorb that into this system and then find out where we need additional resources. Where do we need is additional doctor where we needed additional nurses and other resources to handle this increased its. -- population and also we have to get a sense of how sick they are. I'll be in Massachusetts where they expanded to where there was so full access they found that the that the people that had previously been uninsured. -- actually pretty six and pretty bill needed a lot of resources I would say hadn't anticipated the ball we need to understand. As uninsured now become the -- Now you're an emergency care physician are you exe expecting that perhaps this will lighten the load on the emergency departments that you know you get a lot of times. People who are on the uninsured in coming in very sect. Right and what and that unfortunately what happens is that if they go these newly insured now. One they get to primary care position and sometimes there's delays and then have come into the emerging department -- the experience is that for at least. A couple years as a little bald -- in the emergency department volume until. The primary care system how can absorb these folks into -- -- care and a lot of times. I think that's an -- part of people who don't have -- -- put off getting taking care where they should for a long time and and things are farther along on the disease process could take longer to heal. So once they -- -- hopefully they'll seek a little bit earlier don't prevent them from getting -- -- -- doctor Bruce MacLeod we appreciate you coming in president Al. Something be done so we can keep these great doctors here.