June 22, 2013

U.S. needs injection of primary care

The ranks of the insured will swell next year – and that worries areas already low on family doctors.

By ANN SANNER The Associated Press

(Continued from page 1)

Stephanie Place, Maria Cazho
click image to enlarge

Medical resident Stephanie Place examines Maria Cazho at the Erie Family Health Center in Chicago. Since last summer, Place, 28, has received hundreds of emails and phone calls from headhunters, recruiting agencies and health clinics.

The Associated Press

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"There's going to be lines for the newly insured, because many physicians and nurses who trained in primary care would rather practice in specialty roles," says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

Roughly half of those who will gain coverage under the Affordable Care Act are expected to go into Medicaid, the federal-state program for the poor and disabled. States can opt to expand Medicaid, and at least 24 and the District of Columbia plan to.

In Ohio, which is weighing the Medicaid expansion, about one in 10 residents already lives in an area underserved for primary care.

Mark Bridenbaugh runs rural health centers in six southeastern Ohio counties, including the only primary care provider in Vinton County. The six counties could see some of the state's largest enrollments of new Medicaid patients per capita under the expansion.

As he plans for potential vacancies and an influx of patients, Bridenbaugh tries to identify potential hires when they start their residencies -- several years before they can work for him.

"It's not like we have people falling out of the sky, waiting to come work for us," he said.

State legislatures working to address the shortfall are finding that fixes are not easy.

Bills to expand the roles of nurse practitioners, optometrists and pharmacists have been met with pushback in California. Under the proposals, optometrists could check for high blood pressure and cholesterol while pharmacists could order diabetes testing. But critics, including physician associations, have said such changes would lead to inequalities in the health care system -- one for people who have access to doctors and another for people who don't.

In New Mexico, a group representing dentists helped defeat a bill that would have allowed so-called dental therapists to practice medicine. And in Illinois, the state medical society succeeded in killing or gutting bills this year that would have given more medical decision-making authority to psychologists, dentists and advanced practice nurses.

Other states are experimenting with ways to fill the gap.

Texas has approved two public medical schools in the last three years to increase the supply of family doctors and other needed physicians. New York is devoting millions of dollars to programs aimed at putting more doctors in underserved areas. Florida allowed optometrists to prescribe oral medications -- including pills -- to treat eye diseases.

The federal health care law attempts to address the anticipated shortage by including incentives to bolster the primary care work force and boost training opportunities for physicians' assistants and nurse practitioners. It offers financial assistance to support doctors in underserved areas and increases the level of Medicaid reimbursements for those practicing primary care.

Providers are recruiting young doctors as they gear up for the expansion.

Stephanie Place, 28, a primary care resident at Northwestern University's medical school in Chicago, received hundreds of emails and phone calls from recruiters and health clinics before she accepted a job this spring.

The heavy recruitment meant she had no trouble fulfilling her dream of staying in Chicago and working in an underserved area with a largely Hispanic population. She'll also be able to pay off $160,000 in student loans through a federal program aimed at encouraging doctors to work in areas with physician shortages.

Place said the federal law turned needed attention to primary care as a specialty among medical students.

"Medical students see it as a vibrant, evolving, critical area of health care," she said.

Even so, many experts say the gap between doctors and those gaining care under the health reforms in many parts of the country will not close quickly. Access to care could get worse for some people before it gets better, said Dr. Andrew Morris-Singer, president and co-founder of Primary Care Progress, a nonprofit in Cambridge, Mass.

"If you don't have a primary care provider," he said, "you should find one soon."

 

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