Primary concern: N.C. faces a shortage of family doctors

Charlotte Business Journal – by Jennifer Thomas

North Carolina’s medical school graduates are abandoning the primary-care field despite increasing health-care demands statewide.

And experts believe the trend is exacerbating an existing shortage of primary-care physicians.

About 50% of 2002 graduates from the state’s four medical schools chose primary care. In 2007, only 151 doctors or 38% of those graduates were still in training or practicing, according to a November report compiled by the N.C. Area Health Education Center and the Cecil G. Sheps Center for Health Services Research.

The annual report monitors graduates entering primary care. It is submitted to the N.C. General Assembly, which set goals in the mid-1990s for medical schools to admit up to 60% of graduates to primary-care residencies.

The medical school class of 2008 saw 226 or 54% enter primary-care residency training.

A growing and aging population combined with soaring chronic disease rates is putting more pressure on primary practitioners and the health-care system. At the same time, medical students are choosing more lucrative specialities because of primary care’s low health-insurance reimbursement rates and increasing workloads. With fewer doctors, patients are experiencing longer waits when they seek care.

Data shows the state’s 2,400 family physicians are about 75% of its projected needs, says Greg Griggs, executive vice president of the N.C. Academy of Family Physicians. “I think there’s a shortage now,� Griggs says. “It’s going to get much worse. It may be a disaster by 2020.�

Primary care includes those specializing in family practice, general practice, internal medicine, obstetrics/gynecology or pediatrics.

The economic crisis in health care is driving doctors from primary care, says Dr. Elizabeth Perry, co-owner of Signature Healthcare in Charlotte. Low-reimbursement rates force doctors to see more patients to make the same amount of money.

Perry’s practice charges a $2,500 annual membership fee that generates income outside of insurance reimbursements. That allows her practice to see fewer patients and provide more personalized care.

“You’re not going to get people to go into primary care until it’s fixed. It’s not going to be a quick fix,� she says.

A recent survey by The Physicians’ Foundation found that 78% of physicians believe there is a shortage of primary-care doctors. The survey included 12,000 physicians, most in family practice, nationwide.

Nearly half of physicians — more than 150,000 doctors nationwide — plan to reduce the number of patients they see or stop practicing within three years.

Increased paperwork and overhead, costs for new technology, such as electronic-medical records, and lower reimbursement rates for services are driving doctors from primary care, says Hayes Woollen, president of Winston-Salem-based Novant Medical Group.

Novant is parent company of Charlotte-based Presbyterian Healthcare.

“I think the overall national shortage we’re seeing in health care is going to have to be addressed at all levels,� Woollen says.

Novant has established a physician partnership model, where it partners with local physicians, providing access to resources, which might not be affordable as an independent physician.

Griggs says expansion of the medical schools, expanded residency slots for doctors-in-training and incentives to encourage students to enter family medicine are necessary.

Primary-care doctors see average salaries between $160,000 and $175,000 per year. A specialist, such as an anesthesiologist, could make as much as $450,000

The state, like the nation, has fallen behind when it comes to training and retaining doctors, says Dr. James McDeavitt, senior vice president of medical education and research for Charlotte-based Carolinas HealthCare System.

“Everybody’s experiencing the same dynamics. All these other states will be going for our doctors. There will be a big drive in the next 10 to 15 years to draw our physicians to other states,� he says.

Charlotte has avoided the shortfall, and should continue to do so, because it is a desirable place to live and work, McDeavitt says.

Carolinas HealthCare trains 25% of the family physicians in the state of North Carolina through its residency program. That program has 51 residents taking part in the three-year family medicine program in Charlotte, Monroe and Cabarrus counties.

It takes seven to 10 years to produce a doctor after they graduate from college, McDeavitt says.

“When you start to feel the effects of the shortage, it’s too late. The pipeline is too long,� he says.

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