Medicare pay cut could hasten health care crisis

BY ROB HOTAKAINEN AND ANDI ATWATER
http://www.kansas.com

Congress is under pressure to fix a national doctor shortage that could worsen on July 1, when physicians who treat Medicare patients will get a 10 percent pay cut.

Some say the situation is dire. One-third of the nation’s active doctors — or roughly 250,000 of them — are over 55 and likely to retire in the next decade. And as graduating students face rising debt loads, the number of applicants to U.S. medical schools is increasing but has not kept pace with the nation’s growing population.

“Part of the reason I’m not retiring is because I’m needed,” said Wichita endocrinologist Richard Guthrie, 72. “Part of it is I’m having too much fun. As long as I’m in good health and there’s a need… I’ll keep doing it.”

A growing shortage of physicians is of particular concern to Wichita health care leaders, who say physician training programs at the University of Kansas School of Medicine-Wichita may be in jeopardy if the state doesn’t help pay for them.

Gov. Kathleen Sebelius earmarked $1 million in her budget this year to the Wichita Center for Graduate Medical Education places, but that isn’t enough, leaders said.

Changes in national accreditation standards, coupled with reduced Medicare funding to hospitals that provide graduate medical education, amount to a projected $9.6 million shortfall this year and $12.5 million shortfall in 2009 for the Wichita programs.

“We’re already behind the eight ball,” said S. Edwards Dismuke, dean of the University of Kansas School of Medicine-Wichita. “We’ve got to stabilize our existing programs in order to go to the next (step), which is increasing the number of doctors we train in residencies in Wichita.”

Congress’ plan

Republican Sen. Pat Roberts of Kansas is among the senators who want to stop the upcoming pay cut. And Congress is considering a bill called the Physician Shortage Elimination Act, which would spend millions to provide more scholarships for medical students and expand residency training programs throughout the country.

“While the president’s budget does not offer any ideas for addressing the physician-payment dilemma, it is undoubtedly one of the biggest challenges that Congress faces,” said Sen. Chuck Grassley of Iowa, the top Republican on the Senate Finance Committee.

If Congress does not act soon, doctors will face a second pay cut — of 5 percent — on Jan. 1, 2009. Roberts fears that if the doctor shortage worsens, elderly Americans will have the most difficulty getting medical care.

The issue is prompting plenty of bipartisan concern, particularly in rural regions.

“I haven’t met a single endocrinologist from upstate New York who is either born or trained in the United States…. You go to any one of our states, the proportion of foreign-born, foreign-trained doctors is huge,” said Sen. Chuck Schumer, D-N.Y.

Guthrie, the Wichita endocrinologist, said there’s a dearth of physicians in his field and a need for his diabetes expertise not only in Wichita but also in rural Kansas, where he holds outreach clinics several times a month.

The shortage has already resulted in a rapid increase nationally in the number of nurse practitioners, advanced nurses who can do the work of most primary-care physicians.

State shortages

State medical societies say there could be a huge shortage by 2020, with the nation as many as 200,000 doctors short.

The problem is underscored at KU’s Wichita campus, which has seen a significant drop this year in medical students going into family medicine, said Rick Kellerman, professor and chair of the family and community medicine department.

This is of key concern to the school, which has led the nation in producing family medicine doctors — and keeping them in the state.

Wichita was home to one of the first four family practice residency programs in the United States.

“Because the ages of family physicians mirrors the baby boomer ages and because family medicine in Wichita began in the late 1960s, those physicians trained in the early 1970s are now reaching retirement age,” Kellerman said.

“This (is occurring) at the same time that need for primary care is increasing due to the aging population (and) chronic disease due to diabetes, etc. In other words, we have a system that has jumped the track.”

In Kansas, 43 percent of practicing physicians are 50 or older. Under the cuts, doctors who treat Medicare patients face a loss of $110 million, or an average of $16,000 per physician.

At the same time, the state’s proportion of Medicare patients — 14 percent — is higher than the national average. More than 383,000 Medicare patients in Kansas could be affected by the cuts.

“It is a significant problem, which we all must address at the federal, state and local levels,” Roberts said.

Doctors are seeking to not only scrap the pay cuts but to get a raise as well. A bill introduced by Sen. Debbie Stabenow, D-Mich., called the Save Medicare Act of 2008, would do just that, increasing Medicare physician payments by 1.8 percent in 2009.

If Congress does not stop the July 1 pay cut, doctors say they’ll respond by reducing staff, deferring the purchase of new equipment, discontinuing nursing home visits and rural outreach, and reducing their workload and hours.

Those findings are part of a survey of nearly 9,000 physicians conducted by the American Medical Association. It also found that 60 percent of the respondents said they would limit the number of new Medicare patients they treat if their pay is cut this summer.

Guthrie said he may be forced to cut his own busy staff. “It’s a shame, and it’s unnecessary,” he said.

There are some positive signs, however.

While the number of medical school applicants nationwide declined from 1997 to 2002, it has risen 7 percent since 2003, according to the Association of American Medical Colleges. The 2007 entering class was the largest in history, with nearly 18,000 first-year enrollees.

AAMC President Darrell Kirch said there’s another good sign: At least 12 new medical schools are in some phase of discussion, which should help ease the shortage in future years.

“After failing to add new capacity for 25 years, we are now responding positively to the real growth and aging of the U.S. population,” Kirch said.

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