Peninsula doctors feel the squeeze


Here’s the scenario: You’re overdue for your annual checkup. You call your family doctor. He says he can fit you in. In four months. Or, worse yet, he tells you he’s closing his practice—joining the exodus of primary care doctors from Monterey County.

In three short years, the number of primary care physicians on Community Hospital’s staff practicing on the Peninsula has plummeted from 49 to 30 — and only 19 of those are accepting new patients. Fewer still are willing to see new Medicare patients.

If you’re lucky, you haven’t noticed. You still have somewhere to go for a nagging cough, a mysterious ache, an annual checkup. But a growing number of your friends and neighbors are getting turned away when it comes to basic health care. A lack of access to primary care results in medical conditions going untreated, crowding of emergency rooms with patients who could be treated in a doctor’s office, higher absenteeism at work and, ultimately, higher insurance premiums.

Primary care doctors—family physicians and general internists—are leaving the field because of age, rising practice costs, declining reimbursement from the government and insurers, and increasing paperwork.

To keep their practices afloat, doctors must see more patients and, in some cases, turn away lower-paying MediCal and Medicare patients in favor of those with higher-paying insurance. But even commercial insurance plans, traditionally coveted by doctors for their better reimbursement, are no longer paying primary care physicians at rates that will sustain a practice.

In the United States, reimbursements have always been higher for doctors who perform procedures such as surgery, endoscopy, or catheterization than for those who treat conditions such as hypertension, diabetes and arthritis. As a result, the primary care doctor is most vulnerable to economic pressures.

Monterey County is far from unique; primary care shortages plague communities nationwide. But ours is made worse by a longstanding Medicare policy that pays doctors here substantially less than their colleagues in Santa Clara, Alameda, or San Francisco counties. The Centers for Medicare and Medicaid Services (CMS) views Monterey County as a rural setting. As a result, our doctors receive lower reimbursement than their “urban” counterparts — even though the high cost of living is obviously comparable. Our doctors shoulder the same expenses — rent, salaries, malpractice insurance, etc. — as their more highly paid colleagues just 50 miles to the north.

A recent U.S. General Accountability Office report documents that Monterey County doctors are seriously underpaid by CMS, but there is no clear relief in sight.

Rep. Sam Farr, D-Carmel, has attempted to resolve the problem, but there appears to be little political support, or empathy, from legislators whose districts enjoy higher reimbursement.

At Community Hospital of the Monterey Peninsula, we have employed a number of strategies to address the critical shortage of doctors. These include a physician recruitment program that, since 2001, has brought 35 doctors to the Peninsula by offering housing loans, salary support, student loans and relocation assistance. Unfortunately, given the economic conditions, only about two-thirds of recruited doctors remain in the area and only a small fraction are practicing primary care.

Community Hospital also instituted a program that allows primary care doctors to spend more uninterrupted time in their offices seeing patients, while designated physicians, called hospitalists, care for the physicians’ hospitalized patients. We continue to study additional strategies to recruit and retain primary care doctors to meet the needs of our community. You can help.

In this election year, health care reform is once again on the national agenda. Regardless of the outcome of the presidential election, a genuine overhaul of Medicare to ensure its long-term viability is likely years away. However, the doctors of Monterey County need relief from unfair Medicare reimbursement practices today. Changing disproportionately low reimbursement requires that our legislators and federal agencies (like CMS) hear from concerned community members, especially those who have been affected by our shrinking supply of physicians. We urge you to write to House Speaker Nancy Pelosi and senators Barbara Boxer and Dianne Feinstein.

And if you’ve been considering firing your primary care physician because he or she can’t squeeze you in, think twice. You could have a hard time finding a new one.


Packer is president and CEO of Community Hospital, where Ellison is chief of the medical staff.

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