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Newly insured to deepen primary care doctor gap

Doctor shortfall is smaller in Ohio than other states.

The nationwide shortage of primary care physicians appears to be less of a problem in Ohio than many other states, but the doctor deficit will become more acute as millions of uninsured Americans gain health care coverage under the Affordable Care Act, experts say.

The shortage of primary care physicians already has resulted in longer waits to see doctors, health clinics relying more heavily on nurse practitioners and physicians assistants and a seemingly inexhaustible workload for many doctors.

“I love what I do, but it can be a challenge sometimes,” said Dr. LaDonna Barnes-Lark as she scrambled from one examination room to another seeing primary care patients at the Dr. Charles R. Drew Health Center in Dayton. “We all could use some help.”

The community clinic is located in one of hundreds of federally designated primary care health professional shortage areas, or HPSA, that have been deemed to have too few active primary care physicians to meet the needs of its residents.

There are currently 57 million people — about 18 percent of the U.S. population — living in a HPSA, including about one in 10 Ohio residents, according to the U.S. Department of Health and Human Services.

And the number of doctors entering the field is not expected to keep pace with the demand. There are about 250,000 primary care doctors presently working in America, and the Association of American Medical Colleges estimates the shortage will reach 30,000 by 2015 and increase to 66,000 in about a decade. In some cases, nurses and physician assistants will help fill in the gap.

Recruiting doctors

But the shortfall is smaller in Ohio than many other states, according to the association, which found the number of active primary care doctors per capita in the state ranged from a low of 84.6 to a high of 95.3 in 2010.

The figures were in line with the national rate of 90.5 and well ahead of states such as Utah, Texas, Idaho and Mississippi, which had the lowest rate in the country of 63.6 primary care doctors per capita.

The greatest need for doctors is typically found in rural areas and poor inner cities, such as Dayton and Cincinnati, where it can take months if not years to hire a doctor.

“It’s taken us almost a year to find the two primary care doctors and the two nurse practitioners we just hired,” said Peggy Vazquez, director of clinical operations at Primary Health Solutions in Butler County, also a designated HPSA. “We have the capacity for three to four more doctors, and we sure need them.

“We had 15,500 patients in 2012, and we’re seeing new patients at a rate of 375 a month,” said Vazquez, whose clinic is now staffed by 14 primary care providers, including six doctors. “And that’s before we even talk about the changes in the health care system.”

The HPSA designation does not mean everyone living in the area lacks access to primary care services, but it highlights the areas most likely to struggle with an onslaught of new patients seeking health care. There are about 1.5 million uninsured Ohioans who could sign up for coverage under the health care law.

“We’re as concerned about that as anybody else,” said Dana Engle, CEO at Springfield’s Rocking Horse Community Clinic, also located in an HPSA. “We have expectations that we’re going to grow quite a bit over the next year or two as the Affordable Care Act is implemented

“At the same time, there’s a shortage of physicians going into primary care,” Engle said. “It’s going to be a challenge for us to meet the demand.”

A flood of of new Medicaid patients would further exacerbate the problem, he said, referring to the state weighing the possibility of expanding eligibility for the federal-state health program for the poor and disabled. Ohio would add an estimated 275,000 new members to its Medicaid roles if a proposed expansion under the health care law is approved by state legislators.

Many new enrollees would likely to turn to public clinics and hospitals that already care for the majority of Medicaid patients and the uninsured, in large part because many private practices are rejecting Medicaid patients to accommodate patients with private insurance, said Gregory Hopkins, executive director of Community Health Centers of Greater Dayton.

Hopkins said recruiting doctors to care for a flood of new patients can be a long, arduous process for a variety of reasons. A federal program helps doctors pay off student loans by encouraging them to work in areas with physician shortages.

“If I can get them here, I can keep them competitively paid and offer them student loan repayments and those kinds of things,” said Hopkins, who is currently trying to hire two new primary care doctors. “But first I have to find someone interested in primary care, then a primary care physician willing to work in Dayton and willing to work with medically under-served patients. It’s not for everyone.”

Retaining doctors

Community Health, like most clinics, must compete for doctors with hospitals and specialty practices that offer more money and prestige.

Only about 21 percent of this year’s graduates at The Brody School of Medicine at East Carolina University have chosen to pursue family medicine, for example. But that was the highest percentage in the country, according to the American Academy of Family Physicians. Only about 16 percent of the 106 graduates of Wright State University’s Boonshoft School of Medicine are expected to pursue family practice.

“A primary care physician probably makes less than half of what a specialist makes,” said Primary Health’s Vasquez. “Their hours are longer, their responsibilities are much more extensive. That’s why there’s such a severe shortage of primary care doctors.

For public clinics, the retention of primary care doctors can be as much of a problem as recruitment as hospitals expand and private practices combine forces, Vasquez said.

“We had an absolutely astounding primary care doctor who was here with us for about a year,” she said. “Then a hospital came along and offered to forgive all of her student debt.

When somebody makes an offer like that how do you say no?”

Barnes-Lark, whose grew up near the Charles Drew clinic, hopes more young people will follow in her footsteps and decide to practice at public clinics after graduating from medical school.

She’s been trying to instill her sense of community involvement in her young protege, Amia Gaines, who has been shadowing Barnes-Lark at the clinic as part of Boonshoft’s Horizons in Medicine program for high school students.

“I’ve been wanting to go into the medical field since I was 11 years old when I used to take care of my grandmother,” said 17-year-old Gaines, also from Dayton. “I want to be able to get up in the morning and want to go to work, and I feel like going somewhere where I can feel like I’m actually helping someone and having that connection with people is what I would love to do. So I would definitely think about going to a clinic like this, rather than a hospital.”

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