Hurting for doctors

Shortage causes problems even for the insured

By Nick Tabor, New Era Staff Writer

Chrissie Johnson, 26, drives to Madisonville every few months to get her 18-month-old daughter prescriptions for soy milk.

Johnson and her husband get food money through Kentucky’s Women, Infants and Children program, which resembles federal food stamps. She can only use the funds for soy milk if she proves her daughter is lactose-intolerant.

Her 7-year-old son uses the same doctor. But when she found a primary-care doctor who agreed to treat her 4-year-old daughter and accept Medicaid payments, she accepted the offer. Since she lives in Crofton, which has no full-time primary care doctor, she’s been trying for years to set all her kids up with Hopkinsville doctors.

“That’s where we do business,” Johnson said on Wednesday, sitting on a sofa in her trailer. “That’s where we shop. It’s where our family and such is.”

This past winter, between prescription runs, stomach bugs, the flu, colds and allergies, she’s had to cart the kids between Madisonville and Hopkinsville many times. With such high gas prices, these trips hurt their family’s budget.

Health officials agree that Christian County has far too few doctors.

According to data reported to the Kentucky Board of Medical Licensure, the county has only one primary care physician for every 2,000 people. Teresa Bowers, Jennie Stuart Medical Center’s physician recruitment director, estimates the ratio closer to one to 4,000.

Kentucky’s average is one doctor for every 1,000 people, according to the medical licensure board’s data.

Bowers said this county also has a serious shortage of specialists.

Jennie Stuart has 18 primary care doctors on its active staff. The New Era reached the offices of 14 this week by phone. Five said they had waiting lists for all new patients, including those with private insurance and those who pay out-of-pocket.

Another five said they currently accept new Medicaid patients. This does not count specialists who also provide some primary care.

Johnson’s situation reflects an important dimension of this area’s doctor shortage. Most insured people can find treatment, even if it means traveling out of the county. The uninsured can often get treatment through St. Luke Free Clinic.

But the shortage strains every part of the local health-care system: It increases doctors’ workloads, leaves St. Luke short on volunteers, and limits options for all patients, often causing them inconvenience and budget problems.

As a result, some who are complacent or can’t afford the gas or time for long trips don’t seek preventive care at all. In the end, this puts an undue burden on Jennie Stuart’s emergency room, Bowers said.

Examining causes

Two national trends help explain Christian County’s shortage.

First, primary care physicians, which rural areas need in higher volumes than specialists, are entering the job market at alarmingly low rates. More are becoming specialists, as these jobs promise better salaries and hours.

Second, rural areas don’t appeal to most doctors entering the workforce, Bowers said.

Demand for their services is high enough that doctors know they can get the kind of practice they want wherever they go, so the surrounding environment becomes a high priority when they consider jobsites, Bowers said. And most prefer working in big cities, she said.

“I’m not selling the hospital when I’ve got to recruit,” she said. “I’m selling the community.”

When she convinces doctors to visit, they usually decide to come work here, she said. But catching doctors’ interest is hard.

Additionally, because the recession has put strains on independent practices, hospitals in urban areas are buying many of those offices out, said Jodi Mitchell, director of Kentucky Voices for Health. New doctors see more security in joining a hospital’s staff than operating independently — as most doctors do here, including most affiliated with Jennie Stuart.

How bad is it?

For the county’s population of roughly 74,000, Jennie Stuart has 74 doctors on its active staff. Beyond the 18 who have adult primary care offices, most are specialists in fields like radiology and oncology. The hospital also has 49 doctors on its associate staff. Most of these doctors live in Tennessee and many commute to Jennie Stuart to work in the emergency room.

Anita Walker, the hospital’s medical staff coordinator, said Jennie Stuart’s members make up at least three-quarters of Christian County’s doctors. Most of these doctors work primarily from their own offices. But as members of Jennie Stuart, they have access to the hospital for surgeries and appointments.

The hospital makes its revenue by charging patients for room rentals, nurses’ services and other expenses, Bowers said. She said doctors typically bill patients separately.

Bowers recruits constantly. She said another three primary care doctors are coming here this summer. But the county is especially short on neurologists and urologists, and it no longer has an ear, nose and throat doctor, she said.

St. Luke, the county’s only free clinic, sometimes has five or six weeks’ worth of patients on its waiting list, said Betsy Bond, the clinic’s director. The only reason is a shortage of volunteers: It has five doctors and two nurse practitioners.

“They keep the place open,” Bond said “They’re our heartbeat.” But having new doctors volunteer for even a couple hours a month would make a substantial difference, she said.

With numerous doctors’ offices backed up even for patients with private insurance, this shortage comes as no surprise.

Sending poor patients to specialists is even harder, said Mona Boyd, St. Luke’s nursing director.

“I don’t want to say it’s because the doctors don’t care,” she said. “It’s just that we don’t have a lot of the specialists in this area that a lot of our patients need.”

Boyd sends patients to Lexington and Nashville for orthopedic and neurological treatment. The process can take weeks, and the trip is long. But patients usually find friends or family members to drive them, Boyd said.

“I hope we don’t run into a problem with transportation, but I’m sure that that’s going to be a problem eventually,” she said.

The U.S. Department of Veterans Affairs pays a local doctor to give veterans primary care, but patients on VA insurance must drive to Nashville for appointments with any specialists, a VA representative said.

Even for patients with private insurance, doctor shortages usually mean less time with physicians and therefore less counseling on diet, weight management, exercise and other personal care, said Elmer Whitler, who researches doctor shortages at the University of Kentucky.

Losing these services drives up public health costs, said Mark Pyle, director of the Christian County Health Department.

“Without adequate preventative services, health care costs increase for the treatment of preventable disease and illness,” Pyle wrote in an email to the New Era. “This applies to access to primary healthcare and oral health.”

Academic studies have drawn conflicting conclusions about the relationships between doctor concentrations and overall health care spending. But on an individual level, steady preventive care typically costs less than treating a disease.

Future outlook

Most forecasts of physician numbers do not look hopeful.

If the Obama administration’s health-care law stands, it will guarantee insurance to roughly 46 million more Americans. This would tighten the doctor supply even more, for metropolitan areas as well as small Kentucky towns.

The aging of the Baby-Boomer generation will likely also increase the volume of care this country needs.

In the last decade, major studies have predicted shortages between 85,000 and 200,000 doctors.

A 2007 report by the Kentucky Institute of Medicine said the state’s doctor shortage had persisted for decades and presented no “quick fix.”

“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 state’s three medical schools are enrolling more students to increase Kentucky’s doctor supply, but it will take several years to see the“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 state’s three medical schools are enrolling more students to increase Kentucky’s doctor supply, but it will take several years to see the effects, Whitler said.

As Bowers searches for doctors willing to move here, she always evaluates whether candidates will settle down and stay for many years.

Jennie Stuart gives out $2,000 scholarships every year to students in Christian and Todd counties interested in attending medical school, she said. In the scholarship’s 10-year history, it has not yet netted any doctors for the Jennie Stuart network, she said. Most recipients have not ended up in medical school. But bowers hopes it will make a difference in the long run.

Doctors who grew up here are the most likely to move here after their residencies, she said.

“Little old Hopkinsville is up against Boston and Chicago and all of these bigger cities,” she said. “They’re not throwing darts at a map and saying, ‘I’m going to Hopkinsville.’” effects, Whitler said.

As Bowers searches for doctors willing to move here, she always evaluates whether candidates will settle down and stay for many years.

Jennie Stuart gives out $2,000 scholarships every year to students in Christian and Todd counties interested in attending medical school, she said. In the scholarship’s 10-year history, it has not yet netted any doctors for the Jennie Stuart network, she said. Most recipients have not ended up in medical school. But bowers hopes it will make a difference in the long run.

Doctors who grew up here are the most likely to move here after their residencies, she said.

“Little old Hopkinsville is up against Boston and Chicago and all of these bigger cities,” she said. “They’re not throwing darts at a map and saying, ‘I’m going to Hopkinsville.’”