Family doctors called scarce
By Euna Lhee
When his colleague departed in December, family doctor Charles Bennett thought he would soon find a new partner for his private practice in Lusby. But he has had no luck for the past eight months.
“I’m still trying to find someone, but I don’t think it will get any better in the foreseeable future,” said Bennett, whose Calvert County practice employs four staff members. “The process is very time-consuming, and I am already very busy as it is.”
Bennett’s troubles stem from the fact that the United States faces a serious shortage of family physicians, especially in rural and poorer communities. There are too few primary care doctors and nurses to meet growing health care needs, according to a report released yesterday by the National Association of Community Health Centers. The study found availability depends on location.
More often than not, fewer clinicians practice in areas that need them most.
“This is the unfortunate reality of our health care system. It’s an example of how the market triumphs over public policy,” said Dan Hawkins, the association’s senior vice president of programs and policy and one of the authors of the report. “Even if universal health care comes into play tomorrow, not everyone would have access to a health care provider.”
Although many of these people are insured, 56 million Americans do not have a regular source of health care due to shortages of physicians in their communities, according to the online report. Hawkins said that this translates to poorer health outcomes and less coordinated care for this group.
The study estimates that, in order to provide services to these medically disenfranchised Americans as well as current patients, health centers will need up to 60,000 more primary care professionals, and up to 44,500 additional nurses.
For Maryland, this would translate into hiring an additional 133 primary care providers – including doctors, nurse practitioners, physician assistants and certified nurse-midwives – by 2015.
Another report released earlier this year, the Maryland Physician Workforce Study, emphasized that southern and western counties and the Eastern Shore are seeing “critical” physician shortages, which included not only primary care, but also in most specialties, such as dermatology and thoracic surgery.
Overall, Maryland is 16 percent below the national average for the number of physicians in clinical practice, according to the Maryland Hospital Association.
“Maryland is mirroring national trends,” said Dr. Robert Barish, professor of emergency medicine at the University of Maryland and chairman of the steering committee that supervised the study. “For the future, we need to retain at least 50 percent of residents trained inside of Maryland and also make it more attractive for those who want to come from outside the state.”
On of the main factors contributing to the shortage is that too few medical students choose primary care, which includes family practice and general pediatrics, internal medicine, obstetrics and gynecology.
Rich Bryson is a third-year medical student at the University of Maryland. Although he hasn’t finished his clinical rotations, he is already leaning toward a specialty, not primary care. For one thing, he said, there would be lifestyle benefits.
“The hours and pay are better for specialists,” said Bryson, 24, a native of Hagerstown. “And that is definitely appealing.”
In addition, Bryson also worries about his student loans, which he estimates to be around $100,000. “I don’t want to be strapped down with loans forever, and I know that primary care pays on the lower end of the spectrum.”
Bryson alludes to another factor, which is that primary care physicians are not reimbursed to the same level as specialists by insurance companies. Since they are paid lower rates, general physicians need to work more hours to compensate for their rising expenditures, such as malpractice insurance and supplies.
“The largest insurance companies in the state … have not raised their reimbursement rates,” said Calvert County’s Bennett, who now works around 50 hours a week, including some Saturdays. “Ongoing expenses, such as vaccines, cost me more than what the insurance companies pay me.”
Despite these challenges, Bennett remains. “I love what I do, and I get to take care of people on an extended basis,” he said. “I develop a relationship with patients, some through three, four generations.”
Although Dr. Sylvia Batong enjoys practicing primary care for similar reasons, she left the private practice that she shared with Bennett for 15 years.
“It became economically unfeasible,” said Batong, a family practitioner who now practices in Waldorf, in Charles County.
She entered private practice with Bennett in 1992. Starting in 1995, insurance reimbursements became unfavorable, she said. Since then, she saw her income stagnating or declining. In 2000, she took a second job at an urgent care center, which paid at an hourly rate, to support her two children as a single parent. After seven years of working 55 hours a week, she had had enough.
Currently earning an hourly salary, she has vacation time for the first time in her life and works 40 hours a week. The income is comparable to earnings from the two jobs, she said.
“I knew that Dr. Bennett was going to have trouble finding another partner,” Batong said. “I know at least three, four family practices that can’t find anyone, and they’ve been looking longer than him.”
To address these problems, the association’s Hawkins says that politicians need to change their policies and revise the provider payment system to attract more primary care professionals. In addition, he suggests more loan forgiveness programs and economic incentives to encourage medical students to go to underserved areas.
Hawkins said the public needs to become aware of the need for more family doctors. Otherwise, he said, “We’ll all end up in duck soup, to put it politely.”