Last year, the Association of American Medical Colleges predicted a shortage of 45,000 primary care physicians nationwide by 2020. Experts say better pay and better hours are drawing medical students away from primary care to other specialties.
The Medicus Firm, a physician recruiting company, says family practitioners across the nation had an average compensation of $191,000 in 2010. Most of us would consider that good money, but cardiologists, urologists and radiologists averaged more than twice that in compensation. And some surgeons averaged nearly three times as much.
“Many doctors don’t want to work 70 or 80 hours a week anymore. They want to be able to come home to their family at a set time,” said Dr. Stephen Rohn, chief quality officer at Hamilton Medical Center. “It’s becoming more and more difficult to recruit to small communities where the call burden is an issue. More and more physicians want to work in a large group and work set hours.”
In the nation as a whole, there are currently 631 people for each primary care physician. But in Whitfield County the ratio of residents to primary care physicians is 1,078 to one, and in Murray County it’s a whopping 5,791 to one, according to the 2011 County Health Rankings, published by the University of Wisconsin Population Health Institute and funded by the Robert Wood Johnson Foundation.
Dr. Don Thomas has practiced primary care medicine in Whitfield County for more than 50 years. He said that even if a new primary care physician wants to set up his own office, the odds are stacked against him.
“Somebody coming out of medical school right now in internal medicine, family practice, pediatrics, there’s no way they can open up an office on their own. They’d be bankrupt before they ever start,” Thomas said. “They’ve got the debt behind them from school and all the expenses of opening an office. They would have to go to work for an established group, a hospital or some other entity that can pay them.”
The overhead for a medical office is growing because of federal rules, said Rohn, which will force even more doctors to join larger groups or seek employment by hospitals.
“The government is going to be requiring you to report quality data. That’s going to require easily an extra person you are going to have to pay,” Rohn said. “And the government wants medical offices to move towards electronic records, which will be a big expense. Right now, they are offering a little money to encourage physicians to buy electronic medical records. But in two or three years they’ll start penalizing you through Medicare and Medicaid, withholding a certain percentage of your payback if you don’t move to electronic records.”
Thomas said reimbursement is already an issue for many physicians, especially those in primary care.
“A lot of the shortage is because overhead is so high in primary care. You have to have so many employees. Reimbursements just keep going down,” he said. “Most primary care physicians see people at below their actual costs if they are on Medicaid. Medicare, it’s a close to break even thing. The insurance companies have paid better over the years, but they are tending now to say ‘We’ll pay the same thing Medicare does.’”
Rohn said Hamilton is trying to attract more primary care physicians to the area.
“We are visiting residency programs, people who are in training. We are also looking at possibly helping pay for education if they commit to practicing here. And we are reaching out to people who were born locally if we know they are in medical schools to try to encourage them to come back,” he said. “We work with existing groups to see what kinds of physicians they need to fit into their practice. It is a united effort between the existing physicians and the hospital.”
Rohn said the hospital is also looking at trying to attract more nurse practitioners and physicians assistants, who are taking an increasing role in providing primary care, to the area.
“Potentially, if you have a nurse whom you think is a quality nurse you might think about sponsoring them to get their nurse practitioner license if they come back and work for you for several years,” he said.
In the meantime, several organizations are trying to fill the gap in primary care in Whitfield and Murray counties.
The Whitfield County Health Department operates its Medical Access Clinic and Women’s and Children’s Clinic. And Health Department Manager Cheryl Wheeler said school nurses in local school systems often are the only primary care provider some children have.
“Those school nurses are public health nurses, and they operate under public health protocols, so there’s a number of things they can treat,” Wheeler said. “They even have the right under public health protocols to call in some prescriptions for things like sore throat and ear infections. And if the child needs to see a provider and doesn’t have one, they’ll call the health department and we will get them in to be seen.”
Ellijay-based Georgia Mountains Health Services operates a federally qualified health center in Chatsworth and is working with the Northwest Georgia Healthcare Partnership to open a center in Dalton this year in the new Community Center.
Federal health centers target people who don’t have health insurance but provide services to those covered by private health insurance, as well as Medicare and Medicaid, too.