Archive for Sunday, August 11, 2013

Community tries to recruit more primary care providers

August 11, 2013


Jon Stewart has a mission: to make family medicine cool again.

"In the United States, we make TV shows about the emergency room," said Stewart, the CEO of Lawrence's Heartland Community Health Center. "We don't make TV shows about primary care. By comparison, it's not edge-of-your-seat excitement. It's very routine and boring. But it's the difference maker."

Lawrence, like many communities, faces a shortage of primary care providers, a problem that could be worsened if, as expected, the Affordable Care Act adds millions more people to the health-insurance rolls.

As doctors from the baby boomer generation get set to retire, health care providers in Lawrence are working overtime trying to recruit young physicians to the community. While 65 primary care providers — the category includes family and internal medicine, as well as pediatrics — are needed to adequately care for the local population, Lawrence has only about 30 under the age of 60, according to research done by Lawrence Memorial Hospital.

How did the shortage get this way in the first place?

One of the main reasons, experts say, is economics. The pay for primary care doctors lags in comparison to that of many specialty physicians.

"If you become an anesthesiologist, you can make $7 million more in your career than a primary care doctor," said Joshua Freeman, chair of the family medicine department at the Kansas University School of Medicine.

Local response

In the recent Douglas County Community Health Plan, access to care was identified as one of the five major challenges facing the health of the community. The county's 2012 health assessment had found that about a third of Douglas County residents hadn't been to a doctor for a routine visit in the past year, while one in five didn't have a primary care provider. Lack of awareness, health insurance and the number of physicians accepting Medicare and Medicaid were a factor, but so was the shortage of primary care doctors.

Family doctor Sherri Vaughn is approaching her 15th year of practicing in Lawrence. Like many communities across the country, Lawrence is facing a shortage of primary care providers. Vaughn helps recruit primary care physicians for Lawrence Memorial Hospital.

Family doctor Sherri Vaughn is approaching her 15th year of practicing in Lawrence. Like many communities across the country, Lawrence is facing a shortage of primary care providers. Vaughn helps recruit primary care physicians for Lawrence Memorial Hospital.

One of Christy Hitoshi's first tasks after moving to Lawrence three years ago was to establish a relationship with a primary care provider. That proved more difficult than she would have thought.

"I personally found that Lawrence lacked primary care providers in general," said the 40-year-old health care administrator. "It was even more difficult to find one that was within my insurance network. Of the ones that I did locate, they were all on the west side of town and I live in the far east side, which was unfortunate."

She eventually had to choose between two nurse practitioners. After a bad experience with the first one, she fortunately found a better match with the second.

Dan Partridge, director of the Lawrence-Douglas County Health Department, said he believes part of the reason for the shortage locally is that Lawrence has to compete for doctors with nearby big cities with more amenities, like Kansas City, St. Louis and Dallas.

Another challenge Lawrence faces is that it isn't classified as "underserved," meaning that doctors who practice here aren't eligible for tuition reimbursement from the federal government like those who set up shop in rural communities, said Gene Meyer, CEO of Lawrence Memorial Hospital. Meyer said he doesn't foresee the Affordable Care Act making the primary care shortage worse in Lawrence in the immediate future.

"My initial response was that's this is going to be a huge problem right away," he said. "But the fact that Medicaid did not get expanded in Kansas and the insurance exchanges are probably not going to ramp up as aggressively as we initially thought means that the thousands of folks getting new insurance is probably not going to happen for two to three years."

For Heartland Community Health Center, at least, the shortage is affecting them now. Funding in the Affordable Care Act made the clinic a federally qualified health center, giving it the capacity for about 12,000 to 14,000 patient visits a year. To serve that many patients, Heartland would need 5.5 primary care providers; as of now, it has just a part-time medical doctor and full-time nurse practitioner. Heartland plans to hire another provider in the coming months and one more by next summer.

A new generation

JuliAnne Rathbun never thought about doing anything but primary care. Having grown up in a rural Kansas community, she knew the difference family physicians make in the lives of residents.

"They're the doctor you go to for everything," said Rathbun, 24, a student at the KU School of Medicine. "People are very comfortable with family doctors. It's kind of hard when you meet someone once and that's all you see them. They don't get the whole story."

Jonathan Pike, a 25-year-old student at KU's medical school, said the relational aspect of the job can't be overlooked. That really sunk in with him when he worked with a family doctor in his hometown who was delivering the babies of women he once birthed as infants. "To see life through from the beginning to the end, I think, is a real special privilege that not a lot of people are afforded," Pike said.


Mercy 4 years, 8 months ago

Actually the article should have been written to say, "a problem that could be worsened if, as expected, the Affordable Care Act results in many doctors leaving their practice". This is what's taking place.

Keith 4 years, 8 months ago

Any proof for that, or is it a Fox fact?

skull 4 years, 8 months ago

Leaving their practice? Hilarious...what are they joining the rest of the workforce picking up the crumbs the "makers" leave behind?

chootspa 4 years, 8 months ago

Yes. I'm sure they'll all be working at McDonald's tomorrow rather than work under Obamacare. Meanwhile, McDonald's will make sure they stay under 30 hours rather than offer them health insurance.

Sue McDaniel 4 years, 8 months ago

I so agree Mercy, and the ones that do choose to become Doctors are in for a huge financial challenge unless they do the rural program. There is NO help and their interest on large loans with no income starts day 1, not when they make money. Unless you come from money that is a large weight upon shoulders in addition to the stress of the program. The Med schools here seem to do little to try to form their classes into supportive communities unless like college, they are into the party/clique group.

Carol Bowen 4 years, 8 months ago

Risdi, The financial burden of becoming a doctor has been a problem for a long time. How can you attribute the problem to Obamacare?

Richard Heckler 4 years, 8 months ago

There is no proof that there will be a shortage of primary care doctors. In reality there may be no shortage considering specialists were probably primary givers before becoming higher paid specialists. Therefore all that might be necessary is adjusting rates accordingly when acting as a primary care doctor.

It seems this scare about a shortage may be unfounded which if researched might find this thinking was introduced by the medical insurance industry when Obamacare and single payer were both in the headlines. If fiscally responsible single payer were the order of the day where in the world would America find doctors? I say this scare stuff is more speculation than substance.

A lot of human beings simply do not go to see a doctor at the drop of a hat simply because it is not necessary. For whatever reason the scare department of the medical insurance industry is under the impression that the 50 million who cannot afford medical insurance will immediately be seeking appointments the second coverage is available to them.

Kate Rogge 4 years, 8 months ago

I'll bet there is a run on doctors at first. Many of those without medical insurance are likely to have current medical problems they've left untreated because they could not afford to see a doctor. After that first rush, IMO, it will settle down and we'll all be fine.

Richard Heckler 4 years, 8 months ago

I think what we might find is the number of doctors available is being manipulated by Wall Street and other types of investors. Health Care is big business and there are plenty of not care givers who want to make money on the backs of those seeking care.

Of course I place the the medical insurance industry at the top of the list. This industry does not provide health care BUT does take our money and plenty of it. The quality of care one receives depends on how many $$$$$$ one can funnel to the insurance industry. Why in the world should there be a "middle man" taking our money solely for profit?

jaydocky 4 years, 8 months ago

The number of new doctors depends on the number of available residency slots. If there are not enough qualified American new MDs, foreign MDs will fill the slots. Most you you have probably been to well qualified and trained foreign doctors. When programs are cut, like KU Med has been for the last 7-8 years, the number of available residency slots in the state declines. Residents often stay in the region where they trained, so this is critical. You should also be aware that half of MD grads are women now, and many of them are opting for part time (40 hours/week) work. Full time work in medicine is often 80 hours/week these days, which is not usually possible if women want to raise a family.

deec 4 years, 8 months ago

Yup. "The median expected salary for a typical Physician - Family Practice in the United States is $178,705. "

jafs 4 years, 8 months ago

I looked at your links and found them unconvincing.

They seem to offer unrealistic ideas about what the ACA will do. For example, they conflate the new insurance exchanges with Medicare/Medicaid, when they're clearly quite different. The insurance exchanges will be insurance offered and administered by private insurance companies, and won't share the reimbursement rates of M/M.

Why exactly do you think doctors wouldn't like the ACA, in your own words please?

In one of your links, most doctors believe it's a step in the right direction, while most specialists think otherwise. That may be because the ACA is specifically trying to increase the number of primary care physicians, not specialists. Those are, after all, the doctors who deal with most people's health care to a great extent.

jafs 4 years, 8 months ago

I note that you decline to offer your ideas.

And, your first question is different from the assertions in your other posts. Of course higher demand means that we'll need more health care professionals - there are parts of the ACA designed to increase those numbers, like higher compensation for primary care physicians.

The VA, like any other government organization, only works as well as legislators let it work. When underfunded and understaffed, it won't work very well. Ironically, R have cut their funding, while D advocate for higher funding of the VA.

Do you read your own links? The last one points out that the backlog has increased because the Obama administration expanded the scope of VA benefits - hardly the point you were trying to make.

Doug_Mild 4 years, 8 months ago

Except, the actual survey all these links referred to never asked about Obamacare. Instead, it asked a vaguely-worded question about "current changes in the medical system" and then tried to misleadlingly present this as specific discontent with the ACA. Also, the survey used a highly-unorthodox method of sending questions to offices via fax and then waiting for replies, which resulted in a very low rate of returns.

The fact that Obamacare opponents have to rely on these dishonest tactics suggests to me they know that they know they will lose an actual, open debate.

Garth Atchison 4 years, 8 months ago

To all those people who don't have insurance and never have--welcome to the first world! You will soon be able to go to a non-emergency doctor for your basic health needs. Who knows! Maybe we can finally lower some costs with preventative health care, instead of just supplying drugs as a solution. Gasp! Single-payer would have been better, but what can you do when Congress refuses to represent voters needs.

chicago95 4 years, 8 months ago

Increased demand for health services (if it materializes) should provide an incentive to develop alternative modes of care staffed by highter proportions of APRNs, etc., which the AMA has steadfastly resisted. A couple of decades ago, hospitals raised the alarm that the proliferation of surgicenters would result in rampant substandard care. Of course, just the opposite happened. When more patients become informed consumers (rather than just passing costs along to third-party payors), the system will become more responsive to our needs.

Carol Bowen 4 years, 8 months ago

We should explore different ways of supporting talented medical students. Doctors would not need such a high income if they did not have to pay off student loans.

deec 4 years, 8 months ago

The average doctor's student loan debt is about $166K. For lawyers, it's $100K. For primary care doctors, that's a little over 1 year's wages. With incomes in the top 10% of the nation, I don't think we have to worry too much about the struggling doctors.

Carol Bowen 4 years, 8 months ago

The objective is to remove fee for service. There are a few clinics that operate like the Mayo Clinic and more are evolving. Physicians are better able to develop clinics if their education costs are minimal. It's also possible that potential talented students who previously would not consider medical school could increase the doc pop.

Nikonman 4 years, 8 months ago

The one sentence says it all. "If you become an anesihesiologist you can make 7 million more in your career than a primary care doctor." And there is no mention of what the total career earnings are, as an average or by what speciality. We always hear about the earnings gap between CEOs and the average worker. This is a good indication of where the high cost of health care comes from. Average or even well paid people have no chance of ever making money like that.

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