An unhealthy situation for patients

By Cathleen F. Crowley
http://timesunion.com

Dr. Joseph Sellers walks to work at Bassett Healthcare Cobleskill, where he is a primary-care doctor. He lives in Cobleskill, and his son is mayor.

Nineteen years ago, Sellers was lured to Schoharie County because the state promised to repay part of his medical school bills if he set up a practice in an underserved area. He never left.

Sellers sums up Schoharie County like this: “a beautiful place, sparsely populated, a lot of older folks, a less affluent population.”

The county has just 68 doctors per 100,000 residents — compared with 406 per 100,000 in Albany County — and the number is dropping, according to the University of Albany’s Annual Physician Workforce Profile.

Former Gov. Eliot Spitzer proposed a new loan-forgiveness program that would entice new doctors to rural communities like Cobleskill, and his newly sworn-in successor, Gov. David Paterson, has expressed support for the initiative.

But many in the medical community say it isn’t enough.

The program, they say, doesn’t address the overarching problems: exorbitant malpractice insurance premiums, flat Medicare reimbursement rates, a lagging rural economy.

More than one-quarter of New Yorkers live in areas designated “underserved,” which is classified as more than 3,500 people per primary-care doctor, according to the state Department of Health. The Mohawk Valley, the Finger Lakes and the North Country are among the regions struggling to attract doctors. The Health Department estimates more than 300 primary-care physicians are needed to alleviate the shortage. Speciality doctors are hard to find, too.

“If I want to refer someone to a dermatologist or child neurologist, there is nobody available for miles and miles and months and months,” Sellers said.

According to UAlbany’s annual work force report, 91 percent of the state’s doctors practice in urban areas. The highest ratio of doctors is found in the New York City area, where there are 332 doctors for every 100,000 residents. The Mohawk Valley has the lowest ratio: 167 doctors per 100,000 residents.

The Capital Region, which includes Columbia, Greene and Washington counties, has 254 doctors per 100,000 residents, according to the report.

Eight New York counties have no practicing obstetrician, including Herkimer County.

Dr. Suresh Sharma, president of the Herkimer County Medical Society, retired from his obstetrics practice three years ago. He had delivered more than 8,000 babies, but said he was tired of looking over his shoulder.

Obstetricians, on average, receive two or three malpractice complaints over the course of their careers, according to the American College of Obstetricians and Gynecologists, and they pay among the highest premiums for malpractice insurance.

Sharma tried to find someone to replace him, but failed.

“If you are looking for a place to move, you are looking for good schools, good teachers and good hospitals,” he said. “If you don’t have one (of those), you go somewhere else.”

Herkimer County has no acute-care hospital. Little Falls Hospital closed its maternity ward, so families have to go to Oneida County or Otsego County to have a baby, if they go at all.

“There aren’t any young people in the neighborhoods to get pregnant,” Sharma said.

Sharma’s two children are in medical school right now, but they refuse to stay in New York.

“What does that say? It says it’s a broken system,” Sharma said.

State leaders are working on it, said state Health Commissioner Richard Daines.

Former Gov. Spitzer convened a medical malpractice task force to recommend ways to alleviate high insurance costs, and the Health Department has begun revamping the reimbursement rates for Medicaid, the public insurance program for the poor and disabled. However, the reform efforts do not affect the federal rates set for Medicare, the public insurance program for the elderly.

Spitzer also promised $1 billion for revitalization projects in upstate New York, and Paterson has pledged his support for the fund.

The proposed “Doctors Across New York” program is a $15.6 million initiative that would pay doctors’ loans for five years of service in underserved communities. Most young doctors graduate with $160,000 in school debt.

If the state Legislature approves it, $2 million in the 2008-09 fiscal year would be paid toward 100 doctors’ student loans. That would increase to $4 million and an additional 100 doctors in 2009-10.

After two years, the program would pay 30 percent of a doctor’s loan, increasing to 50 percent after three years, and then an additional 25 percent in each of the final two years up to $150,000.

“It’s staggered so the bigger payoff is in the later years of the five years,” Daines said.

If a doctor leaves the program before serving two years, he or she must repay the state with interest.

“I’ve met with hospital leaders and doctors out there and they said to me if we can get these young people here for five years, we know they will love these communities,” Daines said. “They’ll put down roots. We joke that they’ll marry somebody local, they’ll buy a house, they’ll put their kids in school. We really want them to put down roots for a career.”

David Acker, CEO of Canton-Potsdam Hospital in Potsdam, said it was a good start.

“I’m happy to see that the state has recognized the shortage and is trying to do something about it,” he said. But he thinks the effort falls short.

Doctors Across New York would earmark 33 percent of the money for physicians in urban areas and 25 percent for academic medical centers. That leaves less than 50 doctor slots for upstate New York.

In far northern New York, Canton-Potsdam Hospital alone is short 28 doctors, Acker said.

“We admit over 700 patients who come through our emergency room every year who do not have primary-care doctors,” he said. “When you have a total of only 2,500 medical admissions and almost one-third of them don’t have primary-care doctors, that speaks loudly to how significant the primary-care shortage is here.”

Practicing in a rural area is appealing to some.

Elizabeth Paddock, a fourth-year medical student at Albany Medical College, is considering a rural practice. She grew up in Lake George.

“You really are the physician for the town,” Paddock said. “You have a lot of clout in a community.”

An obstacle for young doctors is the social scene, or lack thereof. Medical students often delay marriage, even dating, until the pressures of medical training are over, Paddock said.

“It’s hard to pick up and move to the middle of nowhere when you are single,” she said.

And for those who have a spouse, “if they are in finance, corporate law or hedge funds, they can’t move to the sticks,” she said.

Paddock is dating a third-year medical student and hopes they can arrange their lives around a rural lifestyle.

The question remains, though, whether physicians who participate in the Doctors Across New York program stay after their five years are up.

Sellers, the Cobleskill physician, came to Schoharie County on a loan-forgiveness program that paid a portion of his school bills. The doctor he replaced 19 years ago was there on a federal loan-forgiveness program.

“He stayed four years and left,” Sellers said. “You could say it was a success or failure, but people here had good health care for four years.”

Sellers stayed, even though he still hasn’t paid off his student loans.

Cathleen F. Crowley can be reached at 454-5348, or by e-mail at ccrowley@timesunion.com.

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