ANN ARBOR — Having trouble finding a family doctor? That’s not surprising, depending on where you live.

A year or so ago, I had lunch with Joe Schwarz, a Battle Creek Republican who is a former U.S. representative and state senator, after I visited a public policy course he teaches at the University of Michigan.

Though he’s had a long career in government service — one that’s also included stints as Battle Creek’s mayor and with the U.S. Navy and the CIA — he’s had an even longer one as a still-practicing ear, nose, and throat specialist.

For a long time, he’s been concerned that not enough medical students are going into primary care fields: general and internal medicine, obstetrics, and pediatrics.

“Every time I go to another medical school graduation and hear the number of students who want to specialize in dermatology, I want to throw up,” Dr. Schwarz said.

He blamed this mostly on the largely accurate perception that specialists are more highly paid than general practitioners.

But this summer, the highly regarded Citizens’ Research Council of Michigan completed a study of primary care in the state — and found another reason. There does seem to be an overall shortage of primary care doctors.

The problem seems mostly one of maldistribution, of there being enough or too many physicians in some areas, and not nearly enough in others. “Most of these [shortages] are for facilities that treat high-need populations,” Eric Lupher, the research council’s president, wrote in a recent newspaper op-ed column.

Not surprisingly, the places that have high-need patients tend to be seen as not very desirable places to live or work, including places of intense urban or rural poverty. The research council’s full report, “Where are the Primary Care Doctors,” (online at crc.mich.org ) reveals that Wayne County, which includes Detroit, has the most shortages. Most underserved of all are inner-city areas with exceptionally high infant mortality rates, or where 20 percent of the population lives below the poverty line.

But it’s a dramatically different world next door in largely affluent Oakland County, home to some of the most pricey real estate in Michigan. There, the report found there were at least 10 times as many pediatricians as experts recommend. That also was the case in Washtenaw County, home to Ann Arbor.

But beyond the Detroit area, shortages of pediatricians and other primary care doctors also are huge in some mostly rural counties, from Cass near the Indiana border to the Upper Peninsula’s sparsely populated Keweenaw Peninsula.

Part of the reason for this probably is that most doctors, like everyone else, prefer living in comfortable places. And doctors who treat the poorest patients may have to wait considerable lengths of time for Medicaid reimbursements that are less than the physician might receive from a private insurance company.

The research council suggested a number of policy shifts that might help the situation, including changing payment systems to make compensation for primary care providers more fair than it has been, compared with specialists.

That idea hasn’t exactly caught fire, however, or attracted powerful congressional sponsors. Dr. Schwarz, who knows something about proposing policy legislation and getting it through the Legislature, has a plan. “I believe Michigan should have a Primary Care Scholarship for perhaps 40 to 50 medical students a year,” he told me last week.

He would structure it similar to the benefits veterans receive. Students would get a full scholarship for their tuition and fees, plus a stipend for living expenses.

In return, they would have to pledge to practice medicine for eight years in a primary care field in a part of Michigan where the need exists. He estimates this would cost the state $12 million a year. That would be barely noticeable, in a state budget where prisons cost taxpayers $2 billion a year.

“It would be worth it,” said Dr. Schwarz, who had a reputation as an eagle-eyed budget expert in Lansing.

There seems little doubt of that. What seems to be lacking so far, however, is the political will to get it done.

●

Just wondering: On Sept. 10, the Michigan House began a marathon, 14-hour session that didn’t end until about 4:30 a.m. Sept. 11. That was while they were fighting over expelling two misbehaving lawmakers.

Wouldn’t it be wonderful if lawmakers were willing to devote that kind of dedication to getting a deal to repair the state’s roads?

Jack Lessenberry, a member of the journalism faculty at Wayne State University in Detroit and The Blade’s ombudsman, writes on issues and people in Michigan.

Contact him at: omblade@aol.com

First Published September 18, 2015, 4:00 a.m.