New Survey to Focus Policy on Physician Shortages

Preliminary data obtained by The Lund Report reveals new wrinkles in physician workforce shortage

This is the third article in the series on the shortage of primary care physicians in Oregon. Also see Part 1 and Part 2.

January 6, 2010 -- Up until now, there’s been plenty of speculation about the severity of the primary care shortage. But with the release of a preliminary survey conducted by the Oregon Medical Association and the state’s Department of Human Services, there’s plenty of cause for concern.
Overall, 3,161 physicians participated in this statewide survey, which was sent to 9,629 doctors last spring. Among the respondents 32 percent were female and 52 percent were over age 50, which indicates the preponderance of middle-aged male doctors across the state.
Even though the survey results won’t be released until late January, Medicaid officials have begun using the data to examine Oregon’s work force shortage, according to Charles Gallia, DHS Division of Medical Assistance Programs research and analysis manager. “It has the potential for far-reaching impact,” he said.
The Lund Report obtained this preliminary data sent to Sen. Jeff Merkley’s office, where it's being used to help craft national health reform legislation. Although the final report may have some revisions and additional data points, officials expect only minor changes. State legislators and state health policy committee members have also been sent a copy of this report by Governor Kulongoski.   
Within the next five years, between 19 and 22 percent of Oregon’s primary care physicians intend to retire – family and general practitioners, obstetricians, gynecologists, internists and pediatricians.
“There’s not a whole lot we can do in terms of directly funding primary care, but data like this should help on the advocacy side,” said Betsy Boyd-Flynn, deputy executive director of the OMA.
The shortage is especially acute outside the concentrated populations near the Interstate-5 corridor, according to the Oregon Office of Rural Health. In the urban communities, there’s a physician for every 298 people, but that number sharply drops down to a 1:744 ratio in the rural areas.
Northwestern Oregon is the most troublesome region. Clatsop, Columbia, Tillamook and Lincoln counties have the highest number of physicians approaching retirement, Gallia said.
To combat this problem, the 2011 legislature needs to restore the loan repayment program that was slashed several years ago and helped primary care physicians, according to Scott Ekblad, who runs the rural health office. “We don’t need more numbers to start working on this problem,” he said.  
As a consistent “yes” voter on funding primary care initiatives, Rep. Mitch Greenlick (D-Portland) echoed Hostetler’s concerns. “Pick a number and let’s start doing something about it; whether we’re short 400 or 600 primary care physicians, it doesn’t really matter,” Greenlick said. “I’m a researcher and I love exact data, but I also know that approximate data works just fine for making policy decisions.”

Medicare Problems

Since 2004, there’s only been a slight change in the number of physicians willing to accept new Medicare patients – a 6 percent decrease – but, at the same time, 15 percent of doctors indicate they’ve closed their doors to seniors. 
“If you’re in the percentage of patients who can’t suddenly find a physician, then that’s a pretty significant change,” said Boyd-Flynn, who’s concerned about physicians’ morale when they’re forced to trim in other places to accept Medicare. 
The biggest factor driving this change – reimbursement – 79 percent of doctors are convinced they aren’t being paid enough by insurers and government-run health plans. 
The economy has taken its toll on the willingness of physicians to take care of charity care patients – 52 percent limit charity care to 1-10 hours, while 29 percent refuse to accept patients who aren’t able to pay and are uninsured.  
There’s still a strong commitment by physicians to either own their practices or become shareholders – 50.5 percent – while 42.2 percent indicated they were employed.
Tort reform isn’t a high priority for physicians who responded to the survey. They ranked liability insurance as their lowest concern compared to issues such as non-compliant patients, administrative requirements and patient load. “I wonder if that reflects the increased percentage of physicians that are buffered by group practices,” said the OMA’s Boyd-Flynn.

Oregon Medical Board Data 

According to the Oregon Medical Board, the state’s licensing agency, there were 10,368 active physicians in 2009, of which 4,881 were pediatricians, internists, family and general medicine doctors, obstetricians and gynecologists. Of the 1,387 physicians who were newly licensed last year, 315 went into primary care, while the 36 osteopathic physicians all chose primary care.
However, these numbers don’t indicate how many physicians actually practice in Oregon, according to the OMB Web site, which states: “There are many physicians with active Oregon licenses who work in administrative or regulatory positions, and there are many physicians with an active Oregon license who are actually retired but have temporarily maintained an active license. Therefore the numbers are not an accurate compilation of working physicians and may lead to a significant overestimation of the potential man/woman power in calculating the number of physicians who care for patients in Oregon.”
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Physician supply logically has dynamic considerations. Other studies suggest as much as half of the medical care services rendered deliver little no medical how should justified and unjustified demand fit into the supply determination? Where does the production and integration of lower cost allied health personnel fit? Gee! How does the cost complaining get reconciled....produce a physician or most any other health care professional and they will strive to make a robust income whether needed or not, and let's face it, we do not have the positioning, administration, legislation, or regulation in place to control costs. If we need more primary care physicians and feel compelled that we must do something about it, what specialists do we have too many of and what are we prepared to do about that? Just souping up supply with no reconciliation to the costs that few want to pay from their own pockets, is at the behavioral core of why we have a screwed up health system.