Health care law brings more patients to already strained doctors
By Laurence Hammack, The Roanoke Times, Va. | |
McClatchy-Tribune Information Services |
Foster lives in rural
"It shoots a day by the time you travel over the mountains," Foster said.
With newfound health insurance required by the Patient Protection and Affordable Care Act, more patients by the thousands will soon be seeking treatment from an already strained system.
Demand for primary care physicians is expected to increase at a time when there's already a shortage of doctors in that field, both nationally and in
Longer waits to see a doctor -- assuming one can be found -- could be in store.
"Just the magnitude of the situation is getting people's attention," said
Currently in
Rural and inner-city regions, for the most part, represent the 78 health practitioner shortage areas in
Topping the list is the
Other areas in
The paucity of primary care physicians is not adequately addressed by the Affordable Care Act, critics say.
"The bottom line is that when they created the legislation, they didn't have a real sense of what the shortage was," said
While much has been made in recent weeks of technical problems that have hindered insurance enrollment on a government-run website, there's also this question: What happens if people with no previous coverage get new insurance cards, but have no easy access to health care?
"Unfortunately, there's not nearly enough in the Affordable Care Act to expand primary care capacity in this country to where it needs to be," said Dr.
And that, Peton said, "is still the 5,000-pound gorilla that the policy makers don't want to discuss."
Searching for a country doctor
With a population of 2,200,
The big attractions here are the mountain ridges and valley farmland, for which the county is called "
Yet there's no doctor of any kind at the
For a year now, officials have been trying to hire someone to replace Dr.
Patients in need of specialized care --
In fact, the most frequent call to the
"We are kind of a poster child, if you will, for medically underserved," said
An influx of new patients with access to insurance through the Affordable Care Act could come at a difficult time.
"It's all the more reason why we need to get a doctor," said
The new health care law requires nearly everyone to have insurance by
An expansion of
Should the program's eligibility requirements be broadened to cover those who make up to 138 percent of the federal poverty guideline, it could mean another 1,300
Many of those people already receive discounted care at the center. But more would likely seek treatment from an operation that is already stretched thin.
Said Klein: "We're pressed against the walls in order to deliver all the services that we want to deliver."
A looming shortage of physicians
Although the situation is not as dire in more populated places, they nonetheless face some of the same challenges that have made finding a physician so difficult in
Namely, a shortage of primary care providers. Just 32 percent of physicians in the United State are primary care doctors, according to Primary Care Progress.
Why? One reason is that primary care physicians make about half of what specialists earn, a gap that can be a career decision-maker for medical school graduates with an average student loan debt of
With such a pay disparity, "we have been discouraging people from going into primary care for years," said Morris-Singer of Primary Care Progress.
The number of primary care doctors in
But according to the state
"That could be really scary," said Dr.
The mission of VCOM, which opened 10 years ago, is to produce primary care physicians willing to practice in medically underserved areas.
Medical school enrollment has increased by 15 percent in
However, the number of residencies -- the on-the-job training required of medical school graduates before they can practice on their own -- is not keeping pace with the growing number of aspiring doctors.
Since 1997,
"There are flat out not enough residency slots to handle the number of students graduating nationwide, which is creating a bottleneck for these slots," said
More health care jobs coming?
It seems simple: Making health insurance more accessible will make more work for the health care industry.
Although that's certainly true -- one study projects 30,000 new jobs if
It's not like the floodgates will open on
Enrollment on HealthCare.Gov, already going slowly because of technical problems, will continue through
The law's rollout will be further delayed in
In the
"It really could have a dramatic increase," said Dr.
Although new jobs are possible, Jeremiah said Carilion would also attempt to better manage existing resources to meet a higher demand at its 45 primary care practices across
For example, if doctors are doing too much paperwork, a team-based approach that already exists would be tweaked to free them up to see more patients.
Jeremiah declined to estimate how many new jobs might be created, should the need persist. "It would be too much of a wild guess," he said.
At LewisGale Regional Health System, president
"There will be an increased demand regardless," he said. "There will be an enhanced increased demand should certain variables play out. How quickly that increased demand materializes, none of us knows for sure."
Like Jeremiah at Carilion, Bartlett declined to estimate how many new jobs might result from higher use of the health care system.
In
While some of that growth was planned as part of the center's expanded location, the Affordable Care Act was also a factor, New Horizons CEO
"We just don't want to get stretched to the point where patients have to wait a month or longer to get in," Lepro said. "That's just not good access."
A rural hospital closes its doors
In
The reduction in federal funds was supposed to be offset by expanding
But that assurance fell through when the
Meanwhile,
"These political decisions clearly can have dire ramifications for small communities and the hospitals that serve them,"
Wellmont also blamed the closure on low use of the hospital and difficulties in finding local physicians to be on call.
The hospital is the first in
The cuts "are just one more hit for a small, rural facility that was already walking on the edge," she said.
Hospitals are often major employers, and l osing one can be a financial blow for a locality.
"Just from a tax-base, never mind the whole human suffering element, the difference between having and not having a hospital in a small community is huge," O'Connor said.
Dr.
Van Zee said Wellmont shuttered the hospital with the expectation that patients would go to other hospitals it runs in neighboring counties, protecting its bottom line -- if not the residents of
"Many lives are at risk," Van Zee said, "and some lives without question are going to be lost."
'A long ride across the mountains'
On a recent Friday afternoon,
As a long time resident of a tiny community (she teaches all 14 of the county's kindergarten students), Foster knows well the trade-offs between city and country living.
"If you're sick after 4 o'clock, you might not get your medicine," she said of a system in which prescriptions from the medical center are filled at a
Despite the inconveniences, Foster had high praise for the medical center staff.
And while it might sound bad to be the state's most medically underserved area, officials at the center hope the recent ranking might actually help in their search for a physician.
Klein said the ranking puts
The health care law seeks to bolster primary care in other ways: boosting
So in places like
"It's a long ride across the mountains with a really sick person, I can tell you that," said
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