Could ‘Obamacare’ worsen Idaho’s doctor shortage?

(TWIN FALLS) TIMES-NEWSNovember 12, 2013 

What happens when previously uninsured Idahoans seek out preventative care as the Affordable Care Act takes effect in the coming months?

What sort of stress will those newly insured patients — 20 percent, according to County Health Rankings and Roadmaps — put on an already stressed medical system?

That’s the million-dollar question, says Neva Santos, executive director of the Idaho Academy of Family Physicians.

“I’m just hoping we have enough physicians to cover all of those patients who want to get in to a physician,” Santos says.

What Santos referenced is a blemish in the state’s medical field. Idaho has struggled to maintain a healthy ratio of patients to physicians. Idaho ranks 47th of 51 states and the District of Columbia in its ratio of primary care physicians to patients, according to the Robert Graham Center, a research and advocacy arm of the American Academy of Family Physicians.

The national benchmark is one primary care physician for every 1,000 patients. Idaho’s ratio is 1,491 patients to each physician.

In the Magic Valley’s eight counties, that ratio is even worse — 1,649:1 in Cassia, 1,761:1 in Twin Falls, 2,869:1 in Minidoka and 5,214:1 in Lincoln, according to County Health Rankings and Roadmaps, a project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Santos says it won’t be easy to attract more doctors. A rural state with no medical school, Idaho has a large physician gap to fill in the next few years if it hopes to keep pace with demand.

Just to maintain the status quo, the Robert Graham Center estimates Idaho will need 382 more primary-care doctors — or 44 percent of the 864-physician 2010 work force — by 2030. Of the increased need, 21 percent will come from the burden of an aging population, 67 percent from population growth and 10 percent — or about 40 physicians — from changes under the Affordable Care Act.

“We just keep working at it, and the numbers are going up — we are doing better — but we still need more primary care physicians,” Santos says.

If physician numbers don’t improve, the situation could become drastic: increased wait lines, higher costs, exacerbated acute medical conditions and a system rendered ineffective, she says.

ST. LUKE’S MAKES HIRING A PRIORITY

It’s proven that a patient who has a good relationship with a primary care provider leads to the highest-quality, lowest-cost care, says Dr. Steven Kohtz, St. Luke’s medical director for primary care in the Magic Valley region.

For that reason, insurance and access are important — fewer patients will need hospitalization and fewer will land in the emergency room. The key is making sure patients get attention when they need it, he says.

Administrators at St. Luke’s Magic Valley and Jerome have made access and recruiting physicians a top priority, says Johanna Stagge, director of primary care. St. Luke’s has added five nurse practitioners and physician assistants, in addition to three family physicians — with a fourth on the way — and a pediatrician this year.

If St. Luke’s can expand its provider base, it may be able to get ahead of the wave of new patients.

“From the outside looking in, I understand it would be nonintuitive that you are hiring all these new primary care providers, how is that going to provide lower cost?” Kohtz says. “But it takes a very small decrease in [hospitalizations and emergency room visits] for you to offset, and then some, the cost of primary care.”

RECRUITING TO RURAL AREAS IS A PROBLEM

Across the state, many physicians are aging and looking to turn their practices over to younger physicians, Santos says. If they leave now, they realize “that community will struggle,” she says.

But recruiting in rural areas like the Magic Valley is a challenge, Santos and Kohtz agree. The top reason an area might struggle to lure doctors, Santos says, is because of a doctor’s spouse: If he or she doesn’t like the community or has a special line of work, the couple will go elsewhere.

“We are working with communities to help them understand what those issues are for them,” Santos says.

Kohtz says St. Luke’s leans on its rural training program for residents — if doctors train in an area, they are more likely to stay, he says. Currently, there are four St. Luke’s residents in the Magic Valley and Jerome regions, Stagge says.

It is hard to say how many new physicians St. Luke’s will need to bring to the area to meet its demand, Stagge says. A recent community-health needs assessment across eight counties indicated the need for at least 24 more physicians, he says.

Stagge says St. Luke’s is “well poised” for the next few years.

INITIAL HEADACHES, LONG-TERM OPTIMISM

The Magic Valley-based Family Health Services is also preparing for the wave of newly insured patients, says CEO Lynn Hudgens.

In the past year, the nonprofit community health agency has hired one new physician, two nurse practitioners and a physicians assistant.

Hudgens doesn’t expect Family Health Services to be hit as hard as St. Luke’s or other providers, because many of the patients it now treats — 47 percent — are uninsured. Family Health Services has hired five workers to raise community awareness, promote the new health care marketplaces known as exchanges, and help enroll local uninsured patients.

Many state health care professionals, including Susie Pouliot, are optimistic about Idaho being able to meet physician demand in the long run.

Initially, providers will have headaches, but if the system works correctly, an emphasis on prevention and wellness will help level the systemic pressures, says Pouliot, CEO of the Idaho Medical Association.

“A lot of these people who have not been insured haven’t been accessing care, and they are going to have more acute problems that haven’t been addressed that need to be taken care of immediately,” she says.

POSSIBLE SOLUTIONS

Santos says there are a number of things Idaho could do to increase its chances of successfully navigating the next few years.

The biggest is to help with medical students’ debt loads, she says. If there was a way the state could help with debt reduction, it might be able to lure more physicians. Pouliot agrees and says the Idaho Medical Association has advocated for such measures but hasn’t gotten anywhere in the Idaho Legislature.

The Idaho Medical Association has also advocated for increased access to medical schools and residency training programs, Pouliot says: “Expanding the pipeline, if you will, of getting students and physicians into it with the hopes they will end up practicing in Idaho when they train here and have exposure to our health system in Idaho.”

Idaho natives hoping to go to medical school can apply for a program that allows students in participating states to pay in-state tuition at the University of Washington. While there is no guarantee that students will return to Idaho after residency, Santos says her organization works hard to recruit those physicians back to the state.

Last year, the Legislature increased the number of seats it funded for that program to 25 from 20. (Eight more students go to the University of Utah.) That’s progress, but it’s far from an instant fix to the problem, Santos warns: “It is not going to help for seven years.”

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bsmith@magicvalley.com

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