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| In this March 28, 2013 photo, medical resident Stephanie Place, right, examines 2-month-old twins Abigale, left, and Valeria Lopez as their mother, Carolina Lopez, left, helps, at the Erie Family Health Center, in Chicago. As clinics gear up for the expansion of health insurance, they're recruiting young doctors. Since last summer, Place, 28, a primary care resident at Northwestern University Feinberg School of Medicine in Chicago, has received hundreds of emails and phone calls from headhunters, recruiting agencies and health clinics. The heavy recruitment means she'll have no trouble fulfilling her dream of staying in Chicago and working in an underserved area with a largely Hispanic population. She'll also be able to pay off $160,000 in student loans through a federal program aimed at encouraging doctors to work in areas with physician shortages. |
COLUMBUS, Ohio (AP) -- Getting face time with the family doctor could soon become even harder.
A
shortage of primary care physicians in some parts of the country is
expected to worsen as millions of newly insured Americans gain coverage
under the federal health care law next year. Doctors could face a
backlog, and patients could find it difficult to get quick appointments.
Attempts
to address the provider gap have taken on increased urgency ahead of
the law's full implementation Jan. 1, but many of the potential
solutions face a backlash from influential groups or will take years to
bear fruit.
Lobbying groups representing
doctors have questioned the safety of some of the proposed changes,
argued they would encourage less collaboration among health
professionals and suggested they could create a two-tiered health system
offering unequal treatment.
Bills seeking to
expand the scope of practice of dentists, dental therapists,
optometrists, psychologists, nurse practitioners and others have been
killed or watered down in numerous states. Other states have proposed
expanding student loan reimbursements, but money for doing so is tight.
As fixes remain elusive, the shortfall of primary care physicians is expected to grow.
Nearly
one in five Americans already lives in a region designated as having a
shortage of primary care physicians, and the number of doctors entering
the field isn't expected keep pace with demand. About a quarter million
primary care doctors work in America now, and the Association of
American Medical Colleges projects the shortage will reach almost 30,000
in two years and will grow to about 66,000 in little more than a
decade. In some cases, nurses and physician assistants help fill in the
gap.
The national shortfall can be attributed
to a number of factors: The population has both aged and become more
chronically ill, while doctors and clinicians have migrated to specialty
fields such as dermatology or cardiology for higher pay and better
hours.
The shortage is especially acute in
impoverished inner cities and rural areas, where it already takes many
months, years in some cases, to hire doctors, health professionals say.
"I'm
thinking about putting our human resources manager on the street in one
of those costumes with a `We will hire you' sign," said Doni Miller,
chief executive of the Neighborhood Health Association in Toledo, Ohio.
One of her clinics has had a physician opening for two years.
In
southern Illinois, the 5,500 residents of Gallatin County have no
hospital, dentist or full-time doctor. Some pay $50 a year for an air
ambulance service that can fly them to a hospital in emergencies. Women
deliver babies at hospitals an hour away.
The
lack of primary care is both a fact of life and a detriment to health,
said retired teacher and community volunteer Kappy Scates of
Shawneetown, whose doctor is 20 miles away in a neighboring county.
"People without insurance or a medical card put off going to the doctor," she said. "They try to take care of their kids first."
In some areas of rural Nevada, patients typically wait seven to 10 days to see a doctor.
"Many,
many people are not taking new patients," said Kerry Ann Aguirre,
director of business development at Northeastern Nevada Regional
Hospital, a 45-bed facility in Elko, a town of about 18,500 that is a
four-hour drive from Reno, the nearest sizable city.
Nevada
is one of the states with the lowest rate per capita of active primary
care physicians, along with Mississippi, Utah, Texas and Idaho,
according to the Association of American Medical Colleges.
The
problem will become more acute nationally when about 30 million
uninsured people eventually gain coverage under the Affordable Care Act,
which takes full effect next year.
"There's
going to be lines for the newly insured, because many physicians and
nurses who trained in primary care would rather practice in specialty
roles," says Dr. David Goodman of the Dartmouth Institute for Health
Policy and Clinical Practice.
Roughly half of
those who will gain coverage under the Affordable Care Act are expected
to go into
Medicaid, the federal-state program for the poor and
disabled. States can opt to expand Medicaid, and at least 24 and the
District of Columbia plan to.
In Ohio, which
is weighing the Medicaid expansion, about one in 10 residents already
lives in an area underserved for primary care.
Mark
Bridenbaugh runs rural health centers in six southeastern Ohio
counties, including the only primary care provider in Vinton County. The
six counties could see some of the state's largest enrollments of new
Medicaid patients per capita under the expansion.
As
he plans for potential vacancies and an influx of patients, Bridenbaugh
tries to identify potential hires when they start their residencies -
several years before they can work for him.
"It's not like we have people falling out of the sky, waiting to come work for us," he said.
State legislatures working to address the shortfall are finding that fixes are not easy.
Bills
to expand the roles of nurse practitioners, optometrists and
pharmacists have been met with pushback in California. Under the
proposals, optometrists could check for high blood pressure and
cholesterol while pharmacists could order diabetes testing. But critics,
including physician associations, have said such changes would lead to
inequalities in the health care system- one for people who have access
to doctors and another for people who don't.
In
New Mexico, a group representing dentists helped defeat a bill that
would have allowed so-called dental therapists to practice medicine. And
in Illinois, the state medical society succeeded in killing or gutting
bills this year that would have given more medical decision-making
authority to psychologists, dentists and advanced practice nurses.
Other states are experimenting with ways to fill the gap.
Texas
has approved two public medical schools in the last three years to
increase the supply of family doctors and other needed physicians. New
York is devoting millions of dollars to programs aimed at putting more
doctors in underserved areas. Florida allowed optometrists to prescribe
oral medications - including pills - to treat eye diseases.
The
federal health care law attempts to address the anticipated shortage by
including incentives to bolster the primary care workforce and boost
training opportunities for physicians' assistants and nurse
practitioners. It offers financial assistance to support doctors in
underserved areas and increases the level of Medicaid reimbursements for
those practicing primary care.
Providers are recruiting young doctors as they gear up for the expansion.
Stephanie
Place, 28, a primary care resident at Northwestern University's medical
school in Chicago, received hundreds of emails and phone calls from
recruiters and health clinics before she accepted a job this spring.
The
heavy recruitment meant she had no trouble fulfilling her dream of
staying in Chicago and working in an underserved area with a largely
Hispanic population. She'll also be able to pay off $160,000 in student
loans through a federal program aimed at encouraging doctors to work in
areas with physician shortages.
Place said the federal law turned needed attention to primary care as a specialty among medical students.
"Medical students see it as a vibrant, evolving, critical area of health care," she said.
Even
so, many experts say the gap between doctors and those gaining care
under the health reforms in many parts of the country will not close
quickly. Access to care could get worse for some people before it gets
better, said Dr. Andrew Morris-Singer, president and co-founder of
Primary Care Progress, a nonprofit in Cambridge, Mass.
"If you don't have a primary care provider," he said, "you should find one soon."
