Options for primary care doctors are shrinking

Oct. 23--Nearly a third of Oahu's primary care doctors are no longer accepting new patients.

Many patients are left in limbo as their doctors retire, decline patients on Medicare or Medicaid -- the government health insurance programs for seniors and low-income residents -- or are unwilling to take on those with complicated medical problems due to new payment models that penalize providers for poor patient outcomes.

Oahu doctors

Total surveyed: 463 primary care physicians

Taking all new patients: 246, or 53%

Taking new patients with private insurance: 72, or 16%

Not taking new patients: 145, or 31%

Source: Crown Care LLC

A total of 145 of Oahu's 463 primary care physicians have stopped taking new patients regardless of insurance coverage, according to a study by Crown Care LLC, a Honolulu patient advocacy company. In addition, 72 primary care doctors, or 16 percent, are accepting only privately insured patients.

Many of those who can't find a primary care physician end up not going to the doctor for preventive care. Instead of treating illnesses in a timely manner and as conditions worsen, they often end up in high-cost emergency rooms.

"This is an access-to-care problem," said Dr. Scott McCaffrey, the past president of Hawaii Medical Association, representing 1,100 doctors. "It's delaying access, intervention and appropriate preventive services, which is the best way to lower costs."

Nuuanu resident Alan Yoshida, 61, has been searching for a primary care doctor off and on for about a year and a half since his physician retired. After calling more than half a dozen providers, he was accepted by two doctors, one of whom quit his practice six months later to go to work at a hospital and another who eventually moved out of state.

"We are in limbo again," Yoshida said. "Some offices ask you what is your age, call back and say we're not accepting new patients at this time. I told them, 'I'm in good health. I promise I won't come in more than once a year. I won't cram your schedule too much.' But that didn't matter. They're just overwhelmed. Finding a primary care provider, it's really tough."

Yoshida said it is "really frustrating" that there are so few doctors willing to accept new patients even though he has private insurance through Hawaii Medical Service Association.

"We emphasize we don't have Medicare, we have regular insurance," he said. "It's a critical (situation). Physicians coming out of medical school, they're either not coming to Hawaii or they're working in-house at Queen's or Kaiser so they're just taking the in-house patients."

Fewer independents

As of June, there was a primary care shortage of 228 physicians, according to the University of Hawaii Area Health Education Center.

As more internists and family medicine doctors move into hospital medicine, the pool of independent doctors is shrinking. Thirty percent of Hawaii physicians were employed by hospitals in July 2015, up from 22 percent in July 2012, according to a recent study released by Washington, D.C.-based nonprofit Physicians Advocacy Institute Inc.

"We know there's a big primary care physician shortage, and we know it's growing, and it's worse on the neighbor islands," said Dr. David Derauf, executive director of Kokua Kalihi Valley Comprehensive Health Center. "It seems to be that the capacity is severely limited right now."

Fifty-three percent, or 246 doctors, are accepting new patients in most cases, but some said they would reject certain insurance carriers that were difficult to work with and delayed reimbursements, the Crown Care study found. The survey of 463 active Oahu primary care physicians included internists, family practitioners, geriatricians and certain subspecialists. The survey was conducted between Feb. 11 and Aug. 26.

"There's a surprising and concerning number of primary care physicians not accepting any new patients at all," said Dr. Eileen Hilton, an internist and chief executive officer of Crown Care. "Additionally, our physician population is aging. Many will be retiring or decreasing their practice hours, leading to an even greater shortage of available practitioners. A lot of doctors are taking care of these patients who may well outlive them. You're talking about a large number of people who will not be able to find a primary care doctor."

Hawaii has the second-oldest physician population in the country, with nearly one-third of Hawaii's active physicians 60 years old or older. Many have been in business for years and are at full capacity, said Dr. Christopher Flanders, executive director of the Hawaii Medical Association.

"Physician practices get full and they don't have the time to see other patients, so they've got to close their practices to new patients," Flanders said. "We haven't been able to bring in as many new physicians to fill the need."

Worse for Medicare

Emmanuel Kintu, chief executive officer of the Kalihi-­Palama Health Center, said the shortage has worsened over the past few years, and is even more grave for patients covered by Medicare and Medicaid, which pay less than private insurers for the same services, he said.

"Most of the practices will set aside a number for Medicare and a number for Medicaid. They operate like a business and if the reimbursement is not enough for them to take that kind of patient, they're not going to take that kind of patient," Kintu said. "That really is the challenge for us."

Kailua resident Wendy Jackson, a 61-year-old breast cancer survivor who moved to Hawaii two years ago from Portland, Ore., travels back to Oregon for annual exams from a primary care doctor because she hasn't been able to find one here.

"With my background as a breast cancer survivor, it's really important (to have a good doctor). My general practitioner in Portland was the quarterback for me -- that person is such a key person on your team," she said. "I've wanted to find a great doctor through a referral here. I've tried networking. I really came up with zero. Without a doubt, I would say it's been much more difficult here than it ever was (to find a doctor on the mainland)."

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