Congress seeks to ease doctor shortage

By Halimah Abdullah
http://www.macon.com/

Macon physician Harvey Jones makes less than $60,000 a year, drives a 14-year-old Cadillac and says continued cuts to Medicare reimbursements to physicians mean he is unable to afford medical insurance for himself or his employees.

“All I do is pray. I try to take care of myself. I buy my medicine at Wal-Mart and get buddies to patch me up when I get sick,” Jones said.

Like many of the elderly and low-income patients on Medicare and Medicaid that he treats at his clinic on Pio Nono Avenue, Jones also suffers from hypertension, diabetes and kidney disease. An area hospital threatened to sue him when he was unable to pay $113,000 in hospital bills, he says.

Though he once made more than $100,000 a year and trained as a surgeon, Jones says he’s serving patients who need him the most.

But as he nears retirement age, Jones, 59, say the impact of years of Medicare reimbursement cuts has taken a huge financial toll on his practice. He now finds himself wondering how he will pay for his own care.

“I’m hoping my Medicare will kick in soon,” he said.

Jones is one of the thousands of health-care providers nationwide who will be affected July 1 when physicians who treat Medicare patients find their reimbursements cut by 10 percent. A second proposed pay cut – of 5 percent – is set to take effect Jan. 1, 2009.

Jones and other physicians say continued cuts make it difficult to stay in business.

The problem is exacerbated by a national doctor shortage, and Congress is under pressure to come up with a solution.

Lawmakers and physicians groups fear that if the doctor shortage worsens, elderly Americans – the very patients who are often on Medicare – will have the most difficulty getting medical treatment. The shortage already has resulted in a rapid increase in the number of nurse practitioners, advanced nurses who can do the work of most primary-care physicians.

In Georgia, 40 percent of practicing physicians are over 50, the age at which doctors typically consider cutting back their hours or retiring. By the year 2020, the state will face a shortage of 2,500 doctors, according to a report for the state’s medical colleges by consulting firm Tripp Umbach.

Some say the situation is dire. One third of the nation’s active doctors – roughly 250,000 of them – are over 55 and likely to retire in the next decade. At the same time, more baby boomers will join the Medicare system and the nation’s population will grow by an expected 24 percent.

Low reimbursement rates for Medicare are contributing to a critical shortage of physicians in fields such as family medicine and endocrinology because many graduating medical students, faced with high debt, want to go into higher-paying specialty fields such as cardiology or surgery, according to state and national medical associations.

“You couldn’t bring a young doctor in here because they wouldn’t make anything,” Jones said. “Hell, I don’t make as much as truck drivers or plumbers doing internal medicine.”

All of this is creating a sense of urgency in Washington, where big money is at stake.

Congress is considering a bill called the Physician Shortage Elimination Act, which would spend millions to provide more scholarships for medical students and expand residency training programs throughout the country.

The problem is especially acute in rural regions.

“People talk about the doctor shortage with the baby boomers retiring,” said Maggie Elehwany, vice president of government affairs at the National Rural Health Association. “There’s been a doc shortage in rural areas for years.”

In stretches of rural Georgia where there are no doctors operating family practices, patients rely on hospitals for care. Some lawmakers and health associations see this as a contributor to the escalating cost of health care.

“One of the challenges for rural hospitals is they are the physician of last resort,” said Rep. Jim Marshall, who is on the rural health-care steering committee in Congress. “These are poor counties, and a lot of people are on Medicare and Medicaid, and the reimbursement is terrible. If you can’t get reimbursed, you can’t keep your doors open.”

In Middle Georgia, which includes a high percentage of the state’s rural health providers, the doctor shortage coupled with the rising cost of providing health care has forced doctors to make tough choices.

“The cuts in Medicare are going to mean a lot for them,” said. Dr. Jack Chapman, president of the Medical Association of Georgia. “The people who are out in Middle Georgia, the preponderance of their patients are a mix of Medicare and Medicaid patients. This puts them in a tough situation as far as being able to stay in business,”

Rep. Sanford Bishop, whose district includes some of the wealthiest areas of the state along with poor and rural areas, said many of the doctors he speaks with are concerned about both the reimbursement rate cuts and what they see as a disparity in the amount rural physicians are reimbursed versus urban doctors. He worries that continued cuts eventually will force more doctors to leave his region.

“The few who brave going to the rural areas will move to more lucrative areas,” he said.

In Macon, Jones shares the rural doctors’ pain.

Medicare cuts as well as the rising cost of malpractice insurance have prevented him and his business partner, fellow physician Luther Vance, from buying additional medical equipment, Jones said. The pulmonary functioning machine in their office is broken, and now Jones and his staff refer patients to a hospital for tests that might help detect respiratory diseases.

His monitor for cardiac arrhythmia broke, and he says he can’t afford to replace it.

In Georgia, doctors stand to lose $330 million in payments for caring for the elderly and disabled during the next 18 months, according to the American Medical Association. On average, the pay cuts will cost each doctor in Georgia who serves Medicare patients a total of $17,000 a year.

Altogether, more than 1 million Georgians on Medicare and 441,082 on TRICARE – the health-care program serving active-duty service members, National Guard and Reserve members, retirees, their families and survivors – could be affected by the cuts.

Doctors are seeking not only to scrap the reimbursement cuts but to get a raise as well. A bill introduced by Democratic Sen. Debbie Stabenow of Michigan, called the Save Medicare Act of 2008, would do just that, increasing Medicare physician payments by 1.8 percent in 2009.

If Congress does not stop the July 1 pay cut, doctors say they’ll respond by reducing staff, deferring the purchase of new equipment, discontinuing nursing home visits and rural outreach and reducing their workload and hours. Those findings are part of a survey of nearly 9,000 physicians conducted by the American Medical Association. Among other things, it found that 60 percent of the respondents said they would limit the number of new Medicare patients they treat if their pay is cut

But the doctor shortage also is fueling more interest in the medical profession, according to the Association of American Medical Colleges. The number of medical school applicants declined from 1997 to 2002, but has risen by 7 percent since 2003. While the number of applicants has not kept pace with the nation’s population growth, the 2007 entering class was the largest in history, with nearly 18,000 first-year enrollees.

The association’s president, Darrell Kirch, said there’s another good sign: At least 12 new medical schools are in some phase of discussion, which should help ease the shortage in future years.

In the meantime, doctors like Jones supplement their income with additional work.

“I work for a sleep lab,” Jones said. “They pay good money for sleep studies and research.”
Rob Hotakainen of the McClatchy Washington Bureau contributed to this report.

Editor’s Note: This article originally appeared on macon.com. It has however been moved or deleted. Our editors have been unable to located the original but we will keep it on our site for archiving reasons.