After 17 years as a family practitioner, Ayaz Madraswalla, MD, recently made one of the most painful decisions of his career to remain economically viable: Mansfield Family Practice will no longer accept new Medicare patients. The decision leaves older adults in Windham County – already struggling with a severe shortage of primary care physicians – with one less place to turn to for medical care. “It’s a terrible situation,” said Madraswalla. “But it’s the reality of medicine today.”
In Litchfield County, Dr. William Handelman, a kidney specialist with Nephrology Associates in Torrington, has difficulty finding medical specialists and subspecialists for his patients. Patients who receive Medicaid must travel to the University of Connecticut Health Center in Farmington. Even patients with private health insurance often wait months and travel great distances for an appointment with a specialist.
“Primary care physicians and specialists across the state cannot keep up with demand and it’s impacting everyone whether you have private insurance or receive assistance from Medicare or Medicaid,” said Handelman, a past president of the Connecticut State Medical Society (CSMS). “We’re seeing a huge group of people with health insurance who cannot get in to see a doctor and are going to community health centers in Connecticut and across state borders for care.”
Primary Care Specialty Shortage Hits Home
{media_1}A shortage of physicians is taking a heavy toll on patient access to primary care and high-risk specialty care in Connecticut, with inner city and rural areas such as Windham, Litchfield and New Haven counties among the areas hardest hit, research by the Connecticut State Medical Society shows.
Issues ranging from declining federal reimbursements to the medical malpractice climate in Connecticut are among the reasons so many physicians are thinking of leaving the state, cutting back on high-risk procedures such as neurosurgery and delivering babies, and overlooking the state altogether when thinking about establishing a new practice. Experts expect the physician scarcity in Connecticut to worsen in the next decade just as the demand for medical care escalates to serve a growing aging population and newly insured individuals with the passage of health care reform.
“There will be a large group of patients who won’t have a medical home,” said Handelman.
Where Are The Doctors?
Connecticut is not alone. Nationwide projections of physician shortages by the Association of American Medical Colleges (AAMC) are 50 percent worse than anticipated prior to health care reform. AAMC expects the shortage of specialty doctors will quadruple to 63,000 by 2015. Compounding the problem are the influx of 32 million newly insured patients under reform efforts and the additional 36 million older adults eligible for Medicare. Doctors are getting older, too, with a third expected to retire in a decade.
Connecticut’s unique environment poses special challenges, as well.
•Older adults and aging physicians comprise a larger percentage of Connecticut’s population. “At a time when Baby Boomers are reaching retirement age, Connecticut is not recruiting the highly skilled younger physicians needed to care for an aging population,” said Handelman.
•Although large physician groups are the norm in many states, most Connecticut physicians are in small practices making it difficult for some to keep up with the rising costs of operating a business. “Connecticut is much more like Wyoming or Montana than any other state when it comes to how medical care is delivered,” said Audrey Honig Geragosian, CSMS director of communications. “Seventy percent of the state physicians are members of groups with four or fewer doctors.”
•Connecticut’s professional liability climate with malpractice insurance rates among the highest in the nation is another obstacle. For example, obstetricians and gynecologists in Connecticut have the second largest medical malpractice insurance rate in the nation at $170,000 a year. “Women are having trouble finding an obstetrician who will deliver their babies,” said Honig Geragosian.
Research Captures Snapshot
In the first research of its kind, two studies by the Connecticut State Medical Society provide a troubling snapshot of the state’s healthcare system and physician-based medical care. A 2008 physician workforce survey polled 1,077 physicians in 17 specialties. Findings of a second study looking at the primary care physician workforce (498 family physicians, internists and pediatricians polled) were released this year.
Among the key findings impacting patient care:
• Among primary care physicians, 28 percent of internists, 26 percent of family practitioners and 16 percent of pediatricians were not accepting new patients.
• More than 90 percent of respondents in Litchfield, New London and Windham counties reported recruiting physicians was very or somewhat difficult. It can take months and even years to recruit urologists, orthopedic surgeons and neurosurgeons. Madraswalla, who sits on the board of directors for Windham Community Memorial Hospital, said recruiting an orthopedist can take two to three years.
• 40 percent of physicians are performing fewer high-risk procedures and 34 percent are seeing fewer high-risk patients due to professional liability concerns.
• New patients wait an average of 17 days for an office visit and longer in Hartford, Middlesex, New Haven and Windham counties.
Windham County Faces Shortage
Among the hardest hit communities by the physician shortage are those in Windham County, a rural area located in the northeast corner of Connecticut. Residents of Windham County have seen the largest reduction in the provision of high-risk services, the second largest decrease in care of high-risk patients and the highest percentage of doctors wanting a career change, according to the CSMS surveys.
Mansfield Family Practice – with its five physicians, two physician assistants and a nurse practitioner – can barely keep up with demand. Madraswalla sees 18 to 20 patients a day, many elderly with multiple medical conditions. The practice has Saturday hours and stays open four evenings a week. But it’s still not enough. “This area could support another five family care practitioners,” he said. “I was trained to take care of patients’ lives, not just to manage people. It’s difficult to practice medicine in this environment.”
Most challenging for Madraswalla and all doctors with Medicare patients is the 23 percent cut in federal reimbursement rates effective Jan. 1, 2011 because Congress failed to adjust the “sustainable growth rate formula” used to calculate payments to physicians. Medicare patients comprise 18 percent of Madraswalla’s caseload. “I don’t expect an exorbitant income. But I can’t afford to lose a quarter of my income,” he said. “No small business can afford that kind of a cut.”
Incentives Needed
Doctors and healthcare advocates have proposed incentives to attract young doctors. They range from loan forgiveness programs to physicians who work in underserved areas to increased reimbursement rates for primary care physicians. Danbury Hospital this year received $4.5 million in federal funds to establish a primary care physician residency program that has doctors working at the local community health center. Quinnipiac University this year announced plans to open a medical school with an emphasis on primary care.
After three decades of practicing medicine, Handelman remains hopeful. “At the end of the day, the reason you practice medicine hasn’t changed much,” he said. “It’s all about the personal interaction between the physician and the patient. You need to keep your eye on the prize.”
Magaly Olivero can be reached at molivero AT optonline.net
Another “benefit” of Obama-care
My skin doctor drops my Medicare Advantage Plan insurance plan as of 1/1/11
Thank you Democrats.