FORT WAYNE, Ind. (WPTA) – There’s nothing fancy about Doctor Lisa Hatcher’s office in Columbia City. A few chairs are scattered around a small lobby. A lone receptionist answers calls and confirms appointments behind a sliding window at the reception desk. The exam rooms, lining a narrow corridor beyond the lobby are tidy and spartan. But make no mistake – this rural office is quite busy.
“I see up to 150 patients a week,” says Hatcher, who explains the workload can mean up to 50 patients a day stepping into one of those spartan exam rooms. She’s far from the only doctor struggling to manage cases.
“It’s a strain on the system,” she admits.
Gone of course, are the Norman Rockwell days when family doctors made house calls or were otherwise easily available. In today’s busy and frantic world, doctors are under stress by a system they say is failing them and their patients, who may wait weeks to see their doctor. The problem? There simply aren’t enough primary care physicians.
According to data in the 2017 State Physician Workforce Data Report by the Association of American Medical Colleges, Indiana has 2,676 active primary care physicians. Each of those doctors cares for 2,479 patients. What’s more, 31% of those doctors are age 60 or older, which means many doctors will retire in the near future. That highlights the other aspect of this problem – there aren’t enough new doctors to replace them.
Since 2002-2003, medical school enrollment increased 31% according to the Association of American Medical Colleges. But the problem lies in graduate education opportunities and the availability of residency programs for newly-minted doctors.
Indiana is home to two medical schools: Indiana University School of Medicine (M.D.), and the Marian University College of Osteopathic Medicine (D.O.). Both schools churn out hundreds of graduates each year. But those students are saddled on average, with $250,000 of college debt once they finish their medical education. When the average annual salary for a primary care physician is $150,000, many medical students choose to pursue more lucrative specialties that can pay $300,000 to $600,000 annually. Those financial decision put a clamp on family practices that are struggling to meet demand.
“It’s kind of sad,” exclaimed Dr. Hatcher.
For most patients, the physician shortage results in long wait times. In those cases, patients may end up at out-of-network “quick care” clinics that cost them more money. If you see such clinics opening in high numbers, that’s why.
For Medicare patients, the situation is more severe. New Medicare patients, or those moving to new areas are often turned away. Few primary care doctors accept Medicare patients because the reimbursement rate for services is low compared to private insurance. This drives Medicare patients to seek expensive out-of-network treatment or go without. However, a newcomer to the healthcare business has emerged to fill this gap.
In downtown Fort Wayne, an unremarkable brick building stands at the corner of East Washington and Clay Street. Inside, a few dozen Medicare patients wait in the lobby or in the large “community room” with coffee and a sleek, flat panel television. This is the location of Oak Street Health, a primary care practice that caters exclusively to patients on Medicare and Medicaid. Recently, the company has expanded to cover some Aetna patients.
“We want this place to be open and friendly,” explained Dr. Rupen Amin. Dressed in khaki chinos and a gingham shirt, Dr. Amin is one of the few doctors who chose primary care instead of a more lucrative specialty. “I wanted to help people,” said Amin when asked why he chose this field. Carrying his white lab coat under his arm, Dr. Amin has a casual approach. Indeed, the atmosphere inside the clinic is casual.
“Anyone is welcome to spend time here,” said Amin. “The community room is open for people to relax, have meetings or even study.”
It’s an interesting take on the primary healthcare clinic – bringing people in and exposing them to the brand. Even if they aren’t yet eligible for services. For those who are eligible, the experience is much like a typical clinical experience. The walls may be green, the staff casually dressed, but patients at Oak Street Health receive their full regimen of exams and treatments here. Like all primary care physicians, Dr. Amin and his staff manage the complete “care nexus” for their patients. They conduct annual physical exams, treat colds and refer patients to specialists when necessary. For Medicare patients with no other options, Oak Street Health offers a welcome solution.
“We’ve got a full load of patients, but we always accept more,” said Amin. “We’re always looking for good doctors, too.”
Oak Street health has just over 40 clinics across the Midwest, with the company finding a way to build a successful business model around those low Medicare reimbursement rates. That seems to suggest it’s possible for others to do the same – if they have the will.
Back at Dr. Hatcher’s office in Columbia City, the seasoned physician ponders solutions for the doctor shortage. She says lawmakers are slowly funding more residency slots for young doctors which could encourage them to choose primary care. But the demand is still outstripping the supply.
Each year, hundreds of fourth year medical students learn where they will spend their residencies – on the job training for young doctors who will be supervised at hospitals until they can practice on their one. While many IU and Marian students stay in Indiana for three to seven years training, there are only so many open slots., about 1,400 in Indiana. That means our state loses well qualified students to other states like Ohio, Illinois an Kentucky, where they may spend a significant portion of their medical careers.
In 2017, the state awarded $2.5 million in new funding to open up new residency slots, but Dr. Hatcher thinks more should be done. It’s an issue she says she’ll work on as she prepares to lead the Indiana State Medical Association.
At the same time, Parkview Health, Lutheran and IU health are adding additional primary care doctors to Northeast Indiana, the additions are a drop in the bucket, but don’t begin to address the physician shortage, something Doctor Hatcher says needs to change.
“Especially if you change communities. Where can I find a doc who is still accepting patients?”
For more information about the physician workforce across the country, click here.