Recruiting doctors to rural hospitals isn’t easy.

Terry Purcell, vice president of Ambulatory and Support Services at Blue Mountain Health System, has been recruiting physicians for 18 years. He said it can take about a year to fill a general physician vacancy.“There’s a glut of doctors in Philadelphia, but it’s difficult to recruit doctors to rural areas,” he said.Purcell said that doctors graduate from medical school with a $300,000 to $400,000 debt. They think that jobs in the city will pay more, which could help them pay off their debt quicker. But the cost of living in the city is higher, too.“Sometimes, we might be paying the same or more as the city,” he said. “And still, we have a hard time recruiting doctors.”“It’s increasingly more difficult,” Purcell said. “Everyone is recruiting.”According to the Pennsylvania Department of Health, Bureau of Health Planning, 87 percent of the state’s population lives in one of the state’s 19 urban counties; 92 percent of the doctors practice there as well. That leaves 8 percent of the doctors practicing in one of Pennsylvania’s 48 rural counties.Purcell said that out of all of Pennsylvania’s 67 counties, Carbon County comes in 61st with access to doctors.According to Blue Mountain’s Community Health Needs Assessment, the ratio of people per doctor nationally is 1,040 to 1. In Pennsylvania, that ratio is 1,220 to 1, and in Carbon County it is 2,090 to 1. The news is just as bad for specialties such as dentistry and mental health care providers.The national ratio of population to dentists is 1,340 to 1; in Pennsylvania, it is 1,550 to 1; and in Carbon County it is 2,390 to 1. In mental health, the national ratio is 370 to 1. In Pennsylvania, the ratio is 580 to 1; and 1,840 to 1 in Carbon County.As an incentive to come to Carbon County, Blue Mountain used to be able to offer loan payment assistance to doctors.It was made possible through a federal program that designated the county as an underserved area, Purcell said. But it has been rescinded because the government lumps Carbon County in with the Poconos and the Lehigh Valley.Joseph Seemiller, a medical student at Commonwealth Medical College in Scranton and a 2009 graduate of Palmerton Area High School, said the shortage isn’t because people don’t want to be doctors.“There is still a significant demand for medical school. To my knowledge, all our domestic medical schools have no unfilled seats,” he said.The problem is, he said, “We haven’t increased the number of spots in medical school classes and residencies proportionally to graduate enough new doctors.”Seeing that number increase is something Dr. Joel Rosenfeld, dean of St. Luke’s University Health Network’s medical school, would like to see.Rosenfeld said that in 1996 the federal government froze the number of residencies allowed at a hospital.The concern was that there were too many doctors being trained. Since then, the number has been increased for Idaho and Montana due to a low patient-to-doctor ratio, but it has remained capped elsewhere.Residencies are funded through Medicare, he said, so the number of residencies the government will fund is based on the number of beds in a hospital reserved for Medicare patients.“We have more residents than we are being reimbursed for,” Rosenfeld said.“We do that to ensure good patient care and to fulfill our mission to the community.”Purcell said one thing that helps Blue Mountain is that St. Luke’s partnership with Temple University trains new doctors in the Lehigh Valley.These students do rotations at St. Luke’s campuses, including Miners Campus in Coaldale.The Pennsylvania Bureau of Health discovered that nationally, nearly 67 percent of the medical students who attend medical school and do a residency in the same state will also practice medicine in that state. In Pennsylvania, 58 percent stay here.Since classes began at St. Luke’s, there have been two graduating classes and 30 students, Rosenfeld said. He hopes to have 300 students graduate over the next 10 years.He thinks it’s doable since the medical classes have grown by 15 percent and St. Luke’s has expanded from four to seven hospitals.“It’s a quadruple win,” he said.There will be more physicians for St. Luke’s hospitals and more physicians in the area in general.Temple University’s medical program will become better known.And it provides more opportunities to educate more doctors, he said.