Archive for Sunday, June 23, 2013

Doctor shortage a looming health issue

June 23, 2013


— Efforts to maintain the availability of a good ol’ country doctor began more than a half-century ago when the University of Kansas chancellor sought to lure new physicians through a new tuition program.

Those techniques are getting more creative as Kansas struggles like much of the nation to keep up with the demand for providers as health care coverage expands. Nationally, an Associated Press review finds doctors are preparing for backlogs, and patients could find it difficult to get quick appointments.

Attempts to address the shortage have taken on increased urgency ahead of the law’s full implementation on Jan. 1.

“The demand for primary care is going to far exceed supply,” said Susan Page, CEO of the Pratt Regional Medical Center in south-central Kansas.

A report by the American Association of Medical Colleges found that as of 2010 there were 2,387 active primary care physicians in Kansas, or 84 doctors for every 100,000 residents. Further, the report found that 26 percent of the physicians were over age 60.

Kansas Gov. Sam Brownback and his fellow GOP legislators have refused a federal offer to pay for expanding Medicaid coverage for low-income and disabled residents. Instead, the state privatized the system, rebranding it as KanCare in 2012 to blunt the growth in costs of providing services to 380,000 residents. Expanding Medicaid would add as many as 240,000 to the KanCare system by some estimates.

However, higher education spending cuts over the next two years could stymie Kansas’ efforts to boost the number of new providers to keep up with existing demands.

The Kansas Board of Regents approved tuition increases on Wednesday for the coming year to offset the reductions. Without state support for the Kansas University medical school, many students could get priced out of the market, said Regent Dan Lykins, of Topeka. Estimates are the cuts could cost the state 30 students in training.

“These are all students — a good chance — who would have stayed in Kansas. We’re not going to have them now,” Lykins said.

Lt. Gov. Jeff Colyer, a plastic surgeon, said the health care law wasn’t the target of a 2011 initiative to lure residents to rural Kansas, but it has become an effective tool.

The changes target income tax breaks for counties that lost 10 percent of their population over the last decade. In 2012, further changes eliminating income taxes for certain businesses, including limited liability companies which include medical practices, helped sweeten the pot.

Shannon Cotsoradis, president and CEO of Kansas Action for Children, said such tax breaks are “stop-gap” methods at best to address shortages.

“You recycle providers in rural areas until they move on after a few years,” she said. “It’s not a sustainable solution, and it doesn’t provide stability for these residents.”

Cotsoradis said keeping young doctors in rural Kansas will be continue to be a problem with the lure of more lucrative practices and quality of life in urban areas.

The Pratt hospital, which serves patients as much as two hours away, is undergoing a $31 million expansion and renovation. Page said most patients are able to see a provider within 24 to 48 hours of seeking care, but that may be a physician’s assistant or nurse practitioner instead of a doctor.

“All of us are going to be focusing on the health of the population and keeping people well and out of the hospital,” Page said. “It’s a totally different change of thought. It’s scary. It kind of feels like you have one foot in the boat and one on the dock.”

Colyer said health care was a “dynamic process,” and no one solution will suffice.

“I think this helps us get down the road significantly. I’m sure that we will have to do more things as this comes along,” he said.


LeBo 4 years, 12 months ago

Such an advanced nation that we only can care for the wealthy!

skull 4 years, 12 months ago

Our health system is far from the best in the world. Doctors don't want to live in culturally starved areas of Kansas, despite getting a tax break.

Richard Heckler 4 years, 12 months ago

"Kansas Gov. Sam Brownback and his fellow GOP legislators have refused a federal offer to pay for expanding Medicaid coverage for low-income and disabled residents. Instead, the state privatized the system, rebranding it as KanCare in 2012 to blunt the growth in costs of providing services to 380,000 residents. Expanding Medicaid would add as many as 240,000 to the KanCare system by some estimates."

Not fiscal responsible. So much of the money was coming from OUR federal tax dollars which is one way to bring our tax dollars home.

Instead Kansas republicans decided to give OUR tax dollars to the private insurance industry which is irresponsible. The private insurance industry must pay CEO's, shareholders and contribute to political campaigns out of the same dollar source paying for healthcare. DO YOU WANT your tax dollars spent this way?

skull 4 years, 12 months ago

And the private sector pays for legions of bureaucrats, extravagant conferences, massive marketing campaigns, large stadiums, amphitheaters, and insanely large bonuses like the recently announced ones at _(fill in the blank with your health insurance provider). On top of that, they also boast record profits every year. There is zero evidence to suggest the private sector can run anything more efficiently than the least for those of us that are paying the bills.

tomatogrower 4 years, 12 months ago

Excellent response, skull. Everyone is always touting how wonderful the private sector is, and I just don't see it, unless you are talking small businesses. Haven't they seen how their hero CEO's live? Some of them even have a nanny for each child, not just 1 nanny for all. I suppose that creates some temporary jobs, but good grief raise your own kids.

skull 4 years, 12 months ago

You really believe that, that if they're run inefficiently they'll fail? How simplistic the world must be. I guess you believe health insurance companies should own sports teams, arenas, concert halls, pay for roughly a quarter of the advertising on television, radio, and print media, all while raking in what seems to be ungodly amounts of profits and raising premiums every year. Maybe my cable bill and phone bill should jump by leaps and bounds while the service (especially customer service) continually go down the drain. Maybe the price of gasoline should jump 400% even though the cost of a barrel of oil has only risen 20% in the same amount of time. You know because wages haven't stagnated in the last 20 years while corporate profits set records every year...

You see tread, in reality the free market screws people like us, because we're all just worker bee consumers. It's just about profit, and the healthcare industry now accounts for more than a quarter of the national GDP. If you don't think corporations waste money, you must never have worked for one.

skull 4 years, 12 months ago

I understand free market principles, however, healthcare is in a whole other category. The phone/cable analogy (I see I didn't elaborate enough to keep you on the same page) was solely to show the corporate greed that leads to record profits. We already have a private sector healthcare well is that working for us?

My point is that corporations aren't profitable because they're efficient, but because they're raising rates, paying their workers the same, and pocketing (or wasting) the rest. How is that system going to help our already bloated healthcare system. I work in healthcare and can barely afford my families premiums. Meanwhile the company continues to complain about budgets while the CEO and his administrative staff get stuck on a marooned cruise ship in the Gulf of Mexico (worst corporate retreat ever!). We're already spending more for less. How much more can worker's spend on health insurance? How many more people's lives need to be ruined by medical bankruptcy? And for what? Corporate profits? How is making sure the middlemen conserve their healthy profit margins going to keep this country from spending so much on healthcare?

I don't have issues with profits, until they're bringing the working class in this country to it's knees. Corporations are taking their customers money. I see these things (arenas, teams, etc.) as the waste, not the sign of efficiency, that is costing working American families so much.

Richard07 4 years, 12 months ago

Oh come now. Surely you are not serious? Give me one single example of an industrialized Western country that has a successful state run economy. The old USSR imploded and Cuba is a joke. Even China is insightful enough to be accelerating the privatization of much of their industry including banking. You forget, the people of this great country do not now nor have we ever expected the government to "turn a profit" on anything. We live in a capitalist country or did you forget?

skull 4 years, 12 months ago

They should have failed, as well as the auto industry, with millions of people losing their jobs...that wouldn't have caused many more millions to lose their jobs or anything. With that economic strategy, you better start learning Chinese real know they have a doctor shortage too!

chootspa 4 years, 12 months ago

Especially not when we elect people who claim that the government can't run anything efficiently and try their hardest to prove it.

Mike1949 4 years, 12 months ago

I still think a class action suite against the Kansas legislature that they are not representing all of Kansans as dictated by the constitution. Make every soul connected to Kansas political system pay back in hard money that which they had a hand in stealing from Kansans. That include the Kock brothers!

Richard Heckler 4 years, 12 months ago

Now letters produced by a Freedom of Information Act request reveal that many of these same anti-Obamacare Republicans have solicited grants from the very program they claim to despise. This is evidence not merely of shameless hypocrisy but of the fact that the ACA bestows tangible benefits that even Congress’s most extreme right-wing ideologues are hard-pressed to deny to their constituents.

As I reported here last September, Congressman Paul Ryan, who as Mitt Romney’s running mate in 2012 called for its repeal, sent a letter requesting ACA money for health clinics in his district two years earlier. The Nation has obtained documents revealing that at least twenty other Obamacare-bashing GOP lawmakers have similarly pleaded for ACA funds on behalf of constituents. Among them are Kristi Noem, a Republican lawmaker from South Dakota likely to run for the Senate next year, as well as Ohio Senator Rob Portman, who has been touted as a potential GOP presidential candidate in 2016.

Jonathan Becker 4 years, 12 months ago

Sammie has an alternative to primary care: prayer. And if you're not getting well, then you are not praying enough.

The lack of primary medical care is a serious issue for Kansans. The visionless leadership in Topeka exacerbates the problem.

skull 4 years, 12 months ago

Yes the reason doctors don't want to move to Pratt, Kansas is Obama's fault.

Richard Heckler 4 years, 12 months ago

One of the big problems is so many family care doctors became "specialists" because the insurance industry would pay more to specialists.

How often does one need a specialist or an MRI for that matter? More often than not patients need neither.

That says to me more specialists will revert back to Family practice. It will be a long long long time before a doctors wage of any sort have them in line for food stamps.

Not only that healthy people seldom rush to the doctor's office. We have learned over the years that the human body can heal itself without shoving pharmaceuticals in our mouth. We don't know that pharmaceuticals cure anything.......only remove symptoms.

AS I see it there should not be a massive surge to the doctor's office UNLESS consumers receive a massive dose of commercials scaring them to the doctor's office. I would suggest strongly that medical commercials be removed from the airways for they interfere with patient care and they add bundles to the cost of health care.

Sue McDaniel 4 years, 12 months ago

Here is a thought, Obamacare is not going to work.........duh.........our Gov had nothing to do with that and they are all just not reading it to find out what is in it.....

skinny 4 years, 12 months ago

Would you go to school for ten years only to have the Federal Government tell you that you had to treat the low income and those who refuse to work for free? NOT!

ebyrdstarr 4 years, 12 months ago

Don't people go to med school so they can become doctors and help people? Don't they do this knowing all along that they will have to take an oath to treat the sick and prevent disease wherever possible? If people would be dissuaded from going to med school by the thought that they might have to treat people who couldn't pay full price, I guess I'm ok with those people not being doctors.

Terry Sexton 4 years, 12 months ago

Well, if one works for free, it IS gonna make it harder to pay the doctor.

tomatogrower 4 years, 12 months ago

And yet you expect teachers to do that. Ok, not 10 years, but to make any money they have to go 7 or more years.

Richard Heckler 4 years, 12 months ago

Does Obamacare really say those things?

Considering both Brownback and BUSHCO eliminated a ton of jobs on their watch how will those formerly employed pay for medical care? Where is the new employment Brownback promised as a result of wreckanomics?

Who exactly are these people who refuse to work?

I say some are not aware of how many job applicants show up to be interviewed for a position or how many job applications come in online for one position. The numbers are staggering.

A new store on the Plaza must have had 100 or more show up as the line outside the store was quite long.

We might ask why USA corporations receive tax incentives for opening up factories and retail outlets in other countries?

Richard Heckler 4 years, 12 months ago

The answer is Expanded Medicare Single Payer Insurance for All of us. This would create an estimated 2.4 million jobs while reducing the cost of medical insurance substantially. Everyone would be insured thus eliminating a great big headache.

Let's Compare: Single-Payer (HR 676 and S 703) Expanded Medicare for All Vs. Proposed Healthcare “Private insurance with Public Option” ( very interesting findings) Physicians for a National Health Program

IMPROVED Medicare Single Payer Insurance for ALL would cover every person for all necessary medical care 24/7 to include:

Wellness /prescription drugs / hospital / surgical / outpatient services / primary and preventive care / emergency services / dental / mental health / home health / physical therapy / rehabilitation (including for substance abuse) / vision care / hearing services including hearing aids / chiropractic / medical equipment / palliative care / long term care

No deductibles / No Co-pays

Congress has nothing better to offer. All they and their parrots have is nonsense rhetoric.

skull 4 years, 12 months ago

Yes, let's look at the one semi-comparable example that supports your ideology and ignore all the more equitable comparisons that disagree with your ideology.

skull 4 years, 12 months ago

How about Canada? Or feel free to research the 37 countries whose healthcare systems are more functional and affordable than the makeshift private sector system we have here.

skull 4 years, 12 months ago

Again, thanks for finding one example that agrees with your ideology and completely ignoring the vast amount of data to the contrary. I particularly enjoyed the recommendation by George Will.

I will admit my liberal bias, but half of my family is Canadian (including one primary care physician) and I have had numerous conversations with many Canadian friends and family over the years and they are all stunned when they hear these stories of complaints with their healthcare system, especially when people try to post them as common occurences. They are usually appalled when I tell them about the costs and issues becoming glaringly obvious to most people with the makeshift system we have here. I have yet to find one person dissatisfied with their healthcare, although I'm sure they exist. This is just my experience, but taking my wife to the hospital in Canada was exactly like taking her to one here, took about an hour, received the same antibiotics we knew we needed when we went, but we didn't receive a bill.

I'm sure there are issues, but ours seem to be growing by the day. We're spending more and receiving less every year. Maybe one more attempt to repeal ACA will fix all our problems. It's funny, Canadian "conservatives" don't think of healthcare as a political issue.

skull 4 years, 12 months ago

Sorry to keep you waiting, Google may not be your friend, a quick wikipedia search can point to many studies:

Regarding Canadians satisfaction with their healthcare system: "Canadians strongly support the health system's public rather than for-profit private basis, and a 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported "public solutions to make our public health care stronger."[8][9] A Strategic Counsel survey found 91% of Canadians prefer their healthcare system instead of a U.S. style system.[10][11] Plus 70% of Canadians rated their system as working either "well" or "very well".[12]

A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada[13] while a Strategic Counsel survey in 2008 found 91% of Canadians preferring their healthcare system to that of the U.S.[10][11]

A 2003 Gallup poll found 25% of Americans are either "very" or "somewhat" satisfied with "the availability of affordable healthcare in the nation", versus 50% of those in the UK and 57% of Canadians. Those "very dissatisfied" made up 44% of Americans, 25% of respondents of Britons, and 17% of Canadians. Regarding quality, 48% of Americans, 52% of Canadians, and 42% of Britons say they are satisfied.[12]"

Regarding the extreme costs and lacking results of US healthcare: "Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country.[1]

According to the World Health Organization (WHO), the United States spent more on health care per capita ($8,608), and more on health care as percentage of its GDP (17.9%), than any other nation in 2011. The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most."

skull 4 years, 12 months ago

Regarding uninsured rates and medical bankruptcy: "The U.S. Census Bureau reported that 49.9 million residents, 16.3% of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1% of the population, in 2009). A 2004 Institute of Medicine (IOM) report said: "The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population." A 2004 OECD report said: "With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990." A 2010 report observed that lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States.[2] In 2007, 62.1% of filers for bankruptcies claimed high medical expenses. A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.[3]"

You can find a few horror stories, but many Americans experience those here as well. The numbers collaborated by these studies certainly don't point to anything good coming from the US heathcare "system" aside from corporate profits.

skull 4 years, 11 months ago

So your answer to "A 2010 report observed that lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States" is that I might have to wait 10-12 weeks to get a hip replacement? Or that there were "numerous examples of Canadians who did not get the health care that they needed"? Numerous like 48,000 people who died? How many more in the US didn't get the health care they needed?

Did you even read what I copy/pasted? Our healthcare system is comparable to Mexico and Turkey in terms of coverage, the quality is lower than that of the UK or Canada, leads to lack of ANY care and is the leading cause of bankruptcy, AND we pay more than anyone in the world for it. But I guess not waiting a few extra weeks for a hip replacement is worth it.

Again, we have a private sector system is that working for us?

skinny 4 years, 12 months ago

Merrill, and who do you suppose is going to pay for all this??

Kyle Chandler 4 years, 12 months ago

skinny is my grandpa! LOL, well all of us 'poor' people of course

skull 4 years, 12 months ago

The same people who already are...all of us.

tomatogrower 4 years, 12 months ago

You are already paying for the poor not getting health care. They go to the emergency room after things get really bad, when they might have been treated at a doctor's office for less, and early on, so they recover faster. If the recover slowly, then they can't work. If they don't recover, Social Security is paid to their children. And that's just the monetary cost. The moral cost of not treating the poor is even bigger. And those like Brownback who claim to be Christians are not following the teachings of Jesus. They worship Jesus' death, not what he taught.

Alceste 4 years, 12 months ago

Pratt? A "think tank" "city"? Alceste does not think so, having almost first hand data given the Alceste 5 generations of Kansasness started in that quagmire of a town.....dead ever since the railroad left it in the dry up and go away. Didn't go away....this fact is true.....but to look to Pratt, Kansas USA for ANY kind of useful data is idiotic. It is the Pratt, Kansas types of the state of Kansas who persist and insist in putting rubes into office which dominate the ignorance of the Kansas legislature. Let the folks west of 59 eat cake. They're the one's who control the bulk of the "democratic process" in Kansas anyway....

ravenjayhawk 4 years, 12 months ago

The problem is with the KU med school staff.. Take a look at how many non Kansans are admitted. Many top KU students are not accepted or wait listed. Most KU med students are somewhat encouraged to become hospitalists,which help nothing but the hospitals. All KU med needs to do is find out who wants to actually practice on their own in Ks and teach them. Most instructors themselves know little of actual private practice as they have stayed in the Ed system most if not all of their careers

yourworstnightmare 4 years, 12 months ago

Western Kansas can rely on faith healing, just as they rely on faith for everything else including politics and voting.

akt2 4 years, 12 months ago

Hospitalists actually streamline InPatient care for the primary care physicians as well. The primary care doctors don't have to make rounds but can still be in communication with the hospitalists. They follow up with their primary care physicians after hospitalization. How would a primary care physician even have time to round anymore with a waiting room full of patients at the office.

Cait McKnelly 4 years, 12 months ago

Why the heck would ANY educated person want to live/work in Kansas? Especially when you have the legislature telling you how to do your job right down to putting lies in your mouth and forcing you to tell them?

jafs 4 years, 12 months ago

I thought we had this discussion about "will of the people" rhetoric already.

Lefty54 4 years, 12 months ago

Our failed Governor has ushered in cuts to higher education which will result in fewer doctors and nurses for Kansas. Cuts to the most profoundly disabled among us. Cuts to public education. All for tax cuts for the Koch brothers.

The brain drain out of Kansas is real and getting worse under the current Governor. Young people are embarrassed by Brownback and Kobach and are leaving in droves.

Currahee 4 years, 12 months ago

The problem actually comes around to the insurance system. There are increasing amounts of doctors nationwide who are opting not to take insurance because insurance is dictating what they can do and can't do. Procedures require approval from the insurance and sometimes insurance will require cheaper substitutes before approving expensive procedures and medication. Not taking insurance has let doctors provide better quality of service at the same cost because they don't need administrative personnel to process insurance paperwork.

This problem with insurance also extends to medicare, which has not increased or cut back costs. This hits primary care physicians the most, and a lot have resorted to becoming bankrupt because they keep feeling the squeeze from insurance providers. This will become a problem in the coming decades because you may start to see some physicians not take people on medicare (some even are not now) and the ones who will take these people will find themselves overburdened and unable to provide good service.

Will the ACA force insurers to pay more? Maybe, because it mandates that 80% of premiums be directed towards healthcare and 20% for administrative overhead and profit. But I don't think insurers couldn't increase prices to keep a healthy profit.

I'm not saying get rid of insurance and have people pay out of pocket (although it seems it is much, much cheaper for some procedures. e.g. a CT scan cost a person $5k with insurance, only to find out it was only $250 if they paid cash) or that insurance is great. There obviously is a problem if it's starting to become a nuisance in preventing people getting the care they need.

gr 4 years, 11 months ago

"e.g. a CT scan cost a person $5k with insurance, only to find out it was only $250 if they paid cash"

I believe you would find it's just the exact opposite. Paying by cash is usually higher than insurance. And I'm talking about the total charge, not a copay. It's like the doctor's office ask, cash or insurance and then they give you different charges. A reform would be to have the same charge for all patients. What the patient actually pays would be what the insurance doesn't. But charge all patients the same instead of having different price charts for each patient.

Currahee 4 years, 11 months ago

No no, not the copay:

I think hospitals should be forced to show their prices for procedures... hiding it is uncompetitive.

Nikonman 4 years, 12 months ago

Programs to lure Doctors to rural parts of the state have been tried before and even financed by local organizations, not the state or federal government. As far as I know, none of the programs worked. The Doctors left for areas more flush with money after a year or two. Breaking a contract wasn't a problem for them if they had one. After all, they could easily make up the difference in California , Eastern Kansas, Pacific Northwest, you name it. If there's no big bucks to be made, they won't locate there.

In_God_we_trust 4 years, 12 months ago

I saw on Fox News, "Huckabee", they had three doctors on that are not working with "Obamacare". The Dr. in Wichita, KS charged a monthly fee (the oldest pay the most, (20 yr. old range is the least expensive). The highest (65 years old and older) rate per month was $100/mo. This bought you health care with no record sharing with the government. The amount you pay for coverage counts toward "Obamacare" amount paid for coverage. Hopefully more Dr.'s in this area will provide this type of health care that does not require insurance.

sourpuss 4 years, 12 months ago

Except your money only covers the initial doctor's visit. Good luck with the prescriptions, tests, hospitalizations, and medical equipment. That $100 won't go far.

In_God_we_trust 4 years, 11 months ago

According to the interview, it covers quite a bit. The Dr. also charges only his cost on supplies that are needed. (Very inexpensive). He also makes house calls. Lots of perks that aren't available with the normal system.

kawrivercrow 4 years, 11 months ago

If you get so much as a kidney stone, the doc will do a physical exam, take a history and will be able to nothing else helpful except order a series of X-rays or CT scans, some IV pain meds and call a urology consult that will likely ending up with an invasive procedure. The only thing a primary care doc can do on the cheap is recommend buying a flour sieve instead of a medical-grade urine stone screen to catch the stone if you are man enough to forfeit 21st century care and go home and try to pass the stone on your own. All the things I mentioned will probably cost 10s of thousands of dollars beyond the doc's control.

skull 4 years, 11 months ago

According to the interview, it covers quite a bit...except for any of the things sourpuss mentioned. I hate to say it, because it is glaringly obvious to most people, but you don't pay for insurance to see your doctor when you sprain your is there for EMERGENCIES.

What is your $100 going to get you when you have a heart attack and are life-flighted to the hospital? When you break your leg?

lucky_guy 4 years, 12 months ago

IGWT's response says it all. All this crack medical information on Fox news and Huckabee, that is all you got? Concierge medicine can be had in Lawrence and it is cheaper than the Wichita doc. I would think twice about it though, just ask Michael Jackson about his experience with this, oh, wait, you can't.

Centerville 4 years, 12 months ago

There are some interesting developments in the medical industry: concierge clinics for one, and individual doctors who only take payment at the time of service. This gets everyone out of the the insurance hassle and the government snafu. Plus, costs are lower. Worth your time, money and health to get involved with these. Medicare for all is not the answer. Has anyone seen the low end estimates for Medicare Part B premiums, deductibles and co-pays next year? It's being drug down the drain, too, thanks in part to those charlatans at the AARP.

gr 4 years, 11 months ago

Here's a solution:

For the students: raise tuition, prohibit parking.

For the doctors: increase costs, reduce reimbursement, require more paperwork, tell them which patients they must and must not see.

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