Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=162934
Story Retrieval Date: 12/7/2013 3:40:11 PM CST
There is one primary care doctor for every 1,070 people in Illinois.
That ratio is even worse – one to more than 2,000 people – in certain areas the government considers health professional shortage areas.
Health professionals worry there will be an even greater shortage after 2014 when about 32 million more people are insured, as mandated by the health care reform law and as the baby boomer generation becomes Medicare-aged.
“With health care reform, we won’t have enough people to serve the communities,” said Dr. Javette Orgain, assistant dean of University of Illinois at Chicago Medical School’s Urban Health Program. “We have too many single-organ specialists like nephrology and neurology and cardiology, as opposed to those who can treat the whole person,” she said.
Dr. Russ Robertson chairs the family and community medicine department at Northwestern University Medical School. He also chairs the federal council that makes physician workforce recommendations to Congressional committees and to the secretary of Health and Human Services.
He said not only is there a decline in the number of primary adult care doctors, but there is also a shortage of nurses, physician’s assistants, community healthcare workers and nurses, to name a few.
“The physicians that are in the shortest supply are in general internal medicine and family medicine. Those are the two specialties that are going to be most responsible for taking care of an aging adult population, many of whom will have chronic diseases,” Robertson said.
Orgain said the South Side community health center at which she practices often has double-booked appointment slots and patients may only have about 15 minutes with a doctor.
When health care reform is implemented, Orgain said this scenario may get worse, especially since the health care law mandates no out-of-pocket costs for preventative care services.
“Not only are there issues of longer wait times, there are issues of having to be transported from one place to another to get the care that you need,” Orgain said. “The issue becomes one of access: How long do you have to wait to get an appointment? How long do you have once you get in to that appointment?
Several factors have contributed to the shortage in primary care providers, including an overwhelming trend among medical students to go into specialty fields because they pay better. Generally, Robertson said, family care physicians make about $173,000 on average; specialists can make about $300,000 to $500,000.
Orgain said for primary care physicians, “The hours are long, the work is hard and the pay is not like that of a specialist. It’s [comparable to] a house mortgage, what students have to pay when they come out now. And that’s a significant barrier.”
David Dranove teaches health industry management at Northwestern’s Kellogg School of Management. He said when HMOs were growing in the 1990s, they placed a similar burden on the primary care industry and the trends that emerged then will likely repeat after reform is implemented.
“I predict by the end of this decade we will see that primary care has grown in prominence as a specialty, that the wages of primary care physicians will start to come much closer to the wages of specialists, and we’ll see more specialists taking on some of the primary care responsibilities. We saw that before in the 1990s,” Dranove said, “and I think we’ll see it again.”
Robertson said it won’t be as easy as it sounds for specialists to take on a primary care role.
“While specialists have the capacity to expand their knowledge base and embrace a broader array of care, their training has narrowed their focus,” Robertson said. “So if someone who is a nephrologist or cardiologist decides over a relatively short period of time that they’re going to begin taking care of people who have diabetes, hypertension and obesity-related issues, without some substantial retraining, their capacity to do that will be limited.”
Dranove and Robertson say until the health care market adjusts to the increased demand, mid-level health care providers such as nurse practitioners and physician’s assistants may take on a bigger role in primary care: They will be asked to work more hours and their wages – and numbers – will presumably increase.
“If physicians leverage their time through nurse practitioners,” Dranove said, “then you may be able to get into your doctor’s office just as quickly as you used to. But instead of spending most of your time with your doctor, you might spend most of your time with a nurse practitioner, and the doctor will be there to supervise and make sure the diagnoses and prescriptions are appropriate.”
“I feel strongly that much of the prevention and entry-level care can be very capably provided by mid-level providers,” Robertson said.
Robertson recommends that anyone with insurance and access to a physician become familiar with their family histories and health risks so that they can take preventative measures now and take advantage of existing relationships with health care providers before more patients are added to the market.
He said even those without insurance should not assume a doctor’s visit for preventative care will be prohibitively expensive.
“You can call the physician’s office,” Robertson said, “and say, ‘Look I don’t have any insurance but I’d like to have some kind of an evaluation right now to assess what my risks are and to see if there is anything I need to do to protect my health.’ And often they may quote a sliding scale where, based on the ability to pay, they may have a fee schedule.”