Statistics show tri-city area needs at least 30 more doctors

By T.M. Shultz
http://www.dcourier.com/

Because no one knows how many primary care doctors it actually will take to care for a growing and aging population, an exact number of new primary care doctors needed in Prescott and Prescott Valley is hard to come by.

Officials at Yavapai Regional Medical Center say at least 10 more private practice physicians would help.

Based on a recent set of figures from Arizona State University researcher William Johnson, the Daily Courier estimates that approximately 49 primary care doctors currently are seeing private patients in Prescott and Prescott Valley.

At the request of the Courier, Johnson computed the number of primary care doctors with active licenses in both the city and the town based on ZIP codes. The computer turned up 65 matches. But Johnson offered this powerful caution: He said that doesn’t mean all of those physicians are working full-time or seeing patients in an office setting. Some could be retired or working in a hospital or nursing home or for a private business. Having an Arizona license doesn’t even mean necessarily that a doctor is still in the state.

The Arizona Physician Workforce Study – which Johnson headed in 2005 – found that only about 75 percent of licensed physicians work in group or solo private practices. If that percentage holds true here, it means that in Prescott and Prescott Valley – which have a combined population of 80,030 – only about 49 primary care doctors are in active private practice.

The Graduate Medical Education National Advisory Committee, which makes recommendations to the federal government, recommends that an area Prescott’s size should have from 49 to 79 primary care doctors.

Because Prescott has a significant number of older residents, it makes sense to aim for the greater number, YRMC officials say.

The question is, how to get them?

Carol Galper, director of the University of Arizona’s Rural Health Professions Program, says research shows that doctors often remain to practice in areas in which they complete their residencies. However, she points out, residencies are extremely expensive and extremely regulated – “so this is nothing that can be quickly established.”

Instead, the Prescott area will have to do what every other shortage area in Arizona is doing: Woo primary care doctors here from other states.

Meanwhile, the use of more physician “extenders” – also called midlevels – might help. Extenders include nurse practitioners and physician assistants who work in expanded roles and manage patients’ medical conditions. They can work in doctors’ offices or – as is happening in other parts of the country – in stores like Wal-Mart. However, a spokesperson for Wal-Mart said the company has no plans to bring such medical services to Arizona anytime soon.

But Prescott’s Dr. William Thrift cautions that increasing the use of physician extenders may not be such a good thing, especially if they take up all the simple cases, leaving doctors to deal with only complicated medical problems.

“Throwing more mid-levels in there will just burn out the doctors faster,” Thrift said.

Hospitalists also play a role in freeing up doctors so they have more time to see patients in their offices instead of having to visit them in hospitals.

YRMC uses hospitalists at its locations in Prescott and Prescott Valley. A hospitalist is a doctor who manages the care of patients while they are in the hospital so that private practice doctors needn’t make rounds. Hospitalists work in shifts, with offices and beds at the hospital, and are available 24 hours a day. It’s the fastest-growing area of medicine today.

Peggy Nies, director of the Community Health Center of Yavapai, says YRMC’s hospitalists have made it easier to recruit doctors for the county’s clinics because the county can limit the time its doctors have to spend on call.

Spousal employment is also a big problem for rural doctors.

“Some of our (rural program) grads have not been able to practice in a rural area because their spouse cannot find a job,” Galper said.

Galper says helping new doctors pay off their medical loans would help. The government has loan payback programs for students who agree to practice in an underserved area. But the government tightened its rules for such a designation after 9/11, say YRMC officials. So far in the tri-city area only Chino Valley has it.

Prescott Mayor Jack Wilson says he’s willing to help. He says he’s contacted Sens. John McCain and Jon Kyl to press for a federal underserved area designation for Prescott. Such a designation would help new doctors locating here write off some or all of their student loans.

As for the city donating money to help lure doctors here, Wilson says the city isn’t in a financial position to do that.

Contact the reporter at tshultz@prescottaz.com

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