Primary Care Physicians - A Medical Emergency
New America Media, News Report, Viji Sundaram, Posted: May 18, 2009
Editor’s Note: An aging population and a state in financial crisis are aggravating a severe shortage of primary care physicians and medical technologists. As more doctors seek to become specialists to pay off medical school debts and the government cuts health and human services programs the shortages are becoming more difficult to fill. NAM Health editor Viji Sundaram reports.
BERKELEY, Calif. – Marty Lynch has been trying unsuccessfully to hire primary care physicians and nurses to his clinic to linguistically and culturally match his patient population, who are primarily Latino and African American.
It doesn’t matter which ethnicity you are looking for but “it’s very difficult to find primary care providers,” said Lynch, executive director of LifeLong Medical Care, a not-for-profit primary health care facility that operates nine health centers in Berkeley, Oakland and Marin County.
Primary care providers, in short supply nationwide, are the main source of health care for most Americans.
Why the shortage?
Students graduating from medical school typically owe about $140,000 in loans. They are looking to quickly pay off their debt.
“The pay differentials between primary care physicians and specialty care physicians is wide,” noted Dr. Mark Doescher of the University of Washington School of Medicine, at a recent Association for Health Care Journalists conference in Seattle.
How wide? “In specialty care, physicians can make two to three times as much as primary care physicians,” said Serena Kirk, senior policy advocate of the California Primary Care Association (CPCA), a membership organization of over 700 not-for-profit community clinics and health centers in the state.
Historically, reimbursement rates for procedures performed by specialists have increased, while reimbursement rates for primary care physicians have not even kept up with inflation.
According to a new survey of community clinics, there is not only a shortage of primary care physicians in community clinics, many vacancies in the allied health care sector -- which represents over 200 types of positions -- are becoming increasingly difficult to fill. Allied health professionals are health care practitioners like medical technicians with formal education and clinical training who are credentialed through certification, registration and/or licensure.
“Community clinics represent the front lines of our health care system,” observed Carmela Castellano-Garcia, president and chief executive officer of CPCA. “The economic situation is putting a further strain on our collective safety net.”
The survey, conducted online by Goodwin Simon Victoria Research, focused on 108 community clinics, between Nov. 25 and Dec. 8, 2008. It was funded by a grant to Fenton Communication from The California Wellness Foundation.
According to the most recent employment numbers available from the California Labor Market Information Division and the Federal Bureau of Labor Statistics, California, for example, only has 73 percent of the pharmacists of the national average per 100,000 people.
At LifeLong, which serves around 20,000 patients a year, 40 percent of them being either uninsured or underinsured, Marty Lynch said he is also experiencing difficulty in finding nurses and social workers to fill vacancies.
Unless drastic steps are taken to find a solution, the situation is only going to worsen in the years ahead, say health care providers. In 2030, it is projected that there will be around 70 million people over the age of 65 nationwide.
“Their demand for health care services is going to go up,” said Jane Garcia, chief executive officer of La Clinica de la Raza, which for 38 years has been dispensing health and dental care to the largely uninsured population in the Bay Area through its 27 satellite clinics.
Concerned that the aging population will put more strain on an already economically beleaguered health care industry, the Obama administration is looking for ways to increase primary care physicians and other health care providers.
Federal officials are considering a plethora of proposals, including one that would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants.
Susan Chapman of the Center for the Health Professions at UC San Francisco said allied health workers will become even more crucial as the state’s population ages.
"You can't run a hospital or a clinic without these positions," she is quoted as saying. "Not having enough people to fill these jobs compromises our overall ability to maintain the system in California."
In California, there will be more than one million people over the age of 85 by 2030, according to the U.S. Census. And with more and more health care workers retiring, the California Labor and Workforce Development Agency believes there is a need to educate over 206,000 additional health care professionals by 2014.
The scarcity of workers is driving community clinics to find innovative ways to find solutions. Some are striking partnerships with their neighbors. La Clinica de la Raza, for instance, is partnering with neighboring community colleges to train medical assistants, with the colleges providing the teachers and education materials and la Raza providing clinical training sites.
“We’re training our own community members,” Garcia said of the project the clinic started two years ago.
On May 14, California Governor Schwarzenegger presented a budget plan that would direct the state to seek a federal waiver to permit $750 million in cuts to Medi-Cal, California’s Medicaid program. The waiver is needed to avoid violating provisions of the federal economic stimulus package that would make the state ineligible for some funds.
Other programs that would be affected under the governor’s budget plan include cutting Medi-Cal reimbursements to private hospitals by 10 percent.
The cuts are meant to help the state deal with a $15.4 billion budget deficit that is likely to occur if voters approve some of the propositions in the May 19 special election.
If voters reject those propositions, the governor outlined $800 million in cuts to health and human services programs, including one that will eliminate Healthy Families coverage for some 225,000 children. Healthy Families is California’s version of the federal Children’s Health Insurance Program.
Garcia said that bad though the recession is, there is a “silver lining” in it. “Health care is one of the few sectors that more people will be choosing careers in,” she said.
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User Comments
John on May 27, 2009 at 22:25:34 said:
If you are uninsured and does not have insurance, you should check out the website www.UninsuredAmerica.blogspot.com - John Mayer, California
Cyndy Viars on May 22, 2009 at 11:08:04 said:
I understand that reimbursement rates should be higher and agree that it is far too low. Another solution to consider is loan forgiveness for physicians who choose primary care, internal medicine or gerontology and work in that field for a fair amount of time.
This was done decades ago when the U.S. predicted a shortage of teachers.
gjdagis on May 18, 2009 at 06:30:02 said:
Until the government insurance programs begin paying us appropriately for our services, we will continue to work outside of the health care system or begin charging on a cash only basis. The public has a serious misconception regarding wages of primary providers such as MDs and nurse practitioners. The tons of money spent on health care never reaches OUR pockets ! All other service industries are allowed to charge their own rates for their services and don't function under the onerous danger of malpractice etc. It's a shame that the people who save the most lives are paid among the very least of the professionals in this society !
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