Hopkinsville paper examines doctor shortage, reasons for it

Albert Delaney waits for his wife Agnes in Hopkinsville.
(Photo by Kentucky New Era's Tom Kane)

Nick Tabor of the Kentucky New Era examines Christian County's doctor shortage, with the area averaging just one primary care physician for every 2,000 people. It's the latest health story in the small daily newspaper, which is committed to quality health reporting.

The shortage creates problems for residents, who must either travel to another area to see a doctor or go without preventive services because there is no one to see until serious illness occurs. When that happens, that "puts an undue burden" on the local hospital's emergency room.

The shortage is affected by the fact that "primary care physicians, which rural areas need in higher volumers than specialists, are entering the job market at alarmingly low rates," Tabor reports. "More medical students are becoming specialists, as these jobs promise better salaries and hours." Secondly, it is difficult to recruit doctors to rural areas. "Little old Hopkinsville is up against Boston and Chicago and all of these bigger cities," said Teresa Bowers, Jennie Stuart Medical Center's physician recruitment director. "They're not throwing darts at a map and saying, 'I'm going to Hopkinsville.'"

The problem is not a new one. A 2007 report by the Kentucky Institute of Medicine shows there have been shortage issues for decades. "Even if all the barriers that have prevented a sufficient and well-dispersed supply of physicians were suddenly to disappear, the task of recruiting and educating an ample cohort of doctors would take years to accomplish," it reads.

The problem is liken to worsen, however, if the federal health-reform law is upheld by the U.S. Supreme Court, as 30 million more Americans will have insurance to see the doctor. A recent report found medical school enrollment is up by 30 percent, but more residency placements are needed to accommodate the influx. (Read more)

Local health care centers in Ky. get $16.5 million in federal grants

Kentucky recently received $16.5 million in grant for health care centers as part of the Affordable Care Act.

Recipients include Family Health Center Inc. in Louisville ($5 million); Cumberland Family Medical Center in Burkesville ($4.86 million); Grace Community Health Center Inc. in Knox County ($4.33 million); and Big Sandy Health Care Inc. in Prestonsburg ($977,375). The grants were made through a building-capacity program, reports Greg Kocher for the Lexington Herald-Leader.

Grants given under the "immediate facility improvement program" include $425,000 for Mountain Comprehensive Health Corp. in Whitesburg; $380,000 for Family Health Center Inc. in Louisville; $360,863 for Cumberland Family Medical Center in Burkesville; and $216,543 for Big Sandy Health Care in Prestonsburg.

The awards will help serve about 29,475 new patients, states a news release from the U.S. Department of Health and Human Services. Nationwide, $728 million was awarded for renovation and construction projects. (Read more)

Serious shortage of primary-care physicians expected in Louisville

An aging population, a high number of doctors getting ready to retire, and medical students opting to specialize for better pay and hours are all factors contributing to an expected shortage in primary-care doctors in Louisville.

"By 2020, Jefferson County will need 455 new primary-care doctors — almost as many as the number that work in local medical practices now," reports Patrick Howington for The Courier-Journal. (C-J photo by Matt Stone)

"We see a real workforce crisis in the future — in the immediate future," said Bill Wagner, executive director of Family Health Centers, a group of community clinics that serve low-income residents.

One survey of local physicians found about a third of doctors are 56 or older and are planning to retire within 10 years. Couple that statistic with the fact that the number of American medical-school seniors who entered family-medicine residencies fell from 17 percent in 1997 to 8 percent last year, Association of American Medical Colleges figures show. Part of the reason for the drop is the comparatively low salaries primary care physicians make. On average, they are paid as little as half as much as specialists, such as radiologists and invasive cardiologists.

Though doctor shortages have typically been seen as a rural problem, that's not so anymore. "No matter where you're talking about, we clearly have an aging primary care workforce," because primary care has been "so unpopular," said Dan Varga, chief medical officer of Kentucky's St. Joseph hospitals and a former Louisville internist. (Read more)

Retailers like Walmart, CVS getting into primary care, eyeing the prize that awaits if health reform takes effect in 2014

Last week, a document leaked showing Walmart's intention to become the country's largest provider of primary health services, but the company's interest is not unique. Drug retailers like CVS Caremark and Walgreens are eyeing the same prize: "the millions of Americans with costly illnesses such as diabetes and heart disease," reports Julie Appleby of Kaiser Health News. CVS already has 550 retail clinics, the most in the country. Walgreens has also set up programs aimed at diabetic customers, which includes counseling with pharmacists.

The retail industry is looking at ways it can use its clout to save money and offer a primary care infrastructure that experts say will be short by 21,000 doctors by 2015, largely because of the 30 million more people becoming insured by 2014 under the federal health-care reform law. "It's sad that the existing health care establishment has not figured out a way to make primary care affordable and accessible," said Jerry Avorn, a professor of medicine at Harvard University. "We should not be surprised if someone outside of our world comes in and does it for us."

Costs at retail clinics are "roughly 30 percent to 40 percent less than similar care at a doctor's office and 80 percent cheaper than at an emergency room," Appleby reports, referring to a study in the American Journal of Managed Care. Those savings appeal to insurers. Retail clinic use by people with health insurance increased tenfold from 2007 to 2009, with clinics accounting for 7 percent of all medical visits for 11 common acute conditions, the study found. "If these trends continue, health plans will see a dramatic increase in retail clinic utilization ... particularly among young, healthy and higher income patients living close to retail clinics," the study concluded.

Patients like the clinics for the predictability, with costs made clear ahead of time. And employers — who under the new health law could get incentives to provide wellness programs for their employees — may partner with the clinics to provide blood testing, nutrition counseling and diabetes management. However, there are still many unknowns. While the clinics have proved useful for acute care, it remains to be seen how they will deal with complicated issues like diabetes management.

Some states prevent clinics from employing physicians, nurse practitioners or physician assistants. "Other states cap the number of nurses each doctor can oversee," Appleby reports. The vast majority of clinics are staffed not by doctors, but physician assistants and nurse practitioners. A report by the Convenient Care Association shows 95 percent of the clinicians are nurse practitioners. With these practitioners able to provide basic care, part of the fear among doctors is they will be left to treat only the sickest patients and won't be reimbursed accordingly.

Most of the clinics are in the South and Midwest. In January, Merchant Medicine listed 40 retail clinics in Kentucky, with more to open in 2011. The clinics "are more likely to be in areas with lower overall poverty and only 12.5 percent were in medically underserved areas," Appleby reports, though 21 percent of the U.S. population lives in those areas.

The clinics have typically offered vaccinations and simple physical exams and treatment for strep throat and ear infections, but plan to expand their services and enlarge retail's foothold in the medical world. "Think about Toyota; they didn't start off by competing with Cadillac and BMW. They started with cheap little cars but got better and better over time," said Mark Smith, president and CEO of the California Healthcare Foundation. (Read more)

Primary care and management of chronic diseases could soon be coming to your local Walmart store

Just weeks after announcing part-time employees would no longer receive health insurance benefits, Walmart said Monday it is planning to offer extended medical services in its stores, report NPR's Julie Appleby and Sarah Varney. Since many of its stores are in rural areas, this move could extend medical coverage to people who often can't afford transportation to a doctor. The retailer "sent out a request for partners to help it 'dramatically lower the cost of health care by becoming the largest provider of primary health care services in the nation.'"

In a 14-page request, Walmart asks health-care providers to define their expertise in a variety of medical areas, including managing patients with chronic health problems like asthma, HIV, arthritis, depression and sleep apnea. The retailer is also trying to find health partners who can monitor patients with diabetes and high blood pressure. Appleby and Varney say "The move would capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance." This effort could also capitalize on "collaborations between doctors and hospitals to streamline care and lower costs," they report.

Though expansion of medical services in Walmarts "could help lower costs for some patients and increase access to primary care services," it has its fair share of nay-sayers. Glen Stream, president of the American Academy of Family Physicians, tells Abbleby and Varney that Walmart's "proposal takes health care in the wrong direction by further fragmenting care. Ann O'Malley, physician and senior researcher at the Washington think tank Center for Studying Health System Change, said she's not sure Walmart's approach will work. She said she "would be surprised if this were a model that could truly attack cost problems." Colin McGranahan, retail analyst for Sanford C. Bernstein & Co., said this could simply be a move to boost foot traffic and sales in Walmarts: "If you get someone in the door, you can also sell them milk and a shotgun." (Read more)