SPECIAL REPORT: The Doctor Dilemma

Posted by Cody Holyoke - bio | email

MONTGOMERY, AL (WSFA) -  At 82 years old, Dr. Jim Temple, a self-proclaimed "modern country doctor," does it all.

"I still do a lot of those things that we have always done. It just comes natural for me, so I just continue to do them," Temple explained.

In his 50th year of practicing medicine in Alexander City, Temple keeps a steady load of 45 to 50 patients per day--and the workload keeps growing.

"If you see my office staff in there, all those girls, about three of them don't do anything but paperwork.  Two don't do anything but filing.  It's just a constant thing," Temple said.

The doctor's troubles aren't uncommon in Alabama.

Right now, the number of "primary care physicians" -- doctors in family and internal medicine, pediatrics, and, in some cases, OB/GYN, is dwindling.

Today, 60 out of 67 counties have shortages.  Statewide, there are more than 1,500 patients for every one primary care physician.

It's something health officials are watching closely, especially since the need is expected to grow.

"What happens is the system gets overwhelmed and what you'll see is the shortage gets magnified.  You get people who can retire who retire because they're overwhelmed. They get out sooner, it makes the gap bigger, and the pipeline just never catches up," explained Dr. Don Williamson, State Health Officer.

What's behind the shortage?

Part of the issue is recruiting those doctors.  Only about half of medical students decide to go into primary care.

At UAB's School of Medicine in Birmingham, professors are doing what they can to increase interest in the field.

"We've increased our class size for our medical student class in general.  Two, we've put more of an emphasis on foster and attract people to the idea of doing primary care," said Dr. Jason Morris, Director of the internal medicine courtship at UAB.

About 52% of UAB's last graduating class went into primary care.  Doctors say they're trying to attract new students, but the face of medicine is changing.

"I think that, as technology progresses, and as we become more specialized, unfortunately, it's a little bit inevitable that we've gone that course," Morris said.

Why the change?

Though some UAB medical students want to go into primary care, others, like third year student Jeremy Drake, say it's not for them.

"When I think of primary care and the rotations that I've been on, it's a lot more dealing with chronic problems and things that honestly aren't quite as interesting to me," Drake said.

Being a specialist certainly has its benefits.

According to medical recruitment group Merritt Hawkins & Associates, Drake will make about $481,000 a year as an orthopedic surgeon, on average.  Cardiologists make $419,000, while the family practitioner earns only $170,000.

It's not all about the money, however.

"I realized how important family medicine and family physicians docs were to our family. It was kind of like, you could call them anytime, you could be there whenever you wanted to, and didn't always have to pay them up front," said third year student Jason Kelly.

That's the draw fellow doctors and health experts hope will bring students to rural areas in Alabama.  That, and incentives to help defray education costs.

"As hard as the upward hurdle's going to be in primary care in the near future, anything to help make things a little easier would be helpful," explained third year student Scott Love.

The state is trying to answer the call by way of the Rural Medical Scholars program, a way to keep Alabamians working at home.

"If they're serving in an underserved area, specifically in a shortage area, they can get a loan that then they can pay back by working in that area," Williamson explained.

Federal funding is also available for some students, encouraging them to move into primary care.

"That's a reality of student loans when you come out, and so, to say to one's self, 'I'm going to come out of school to do the same amount of work-potentially more-in a more stressful environment for half the pay,' that's a very big consideration," Morris said.

Finances, however, are only part of the problem.

Doctors say low reimbursements from Medicare and insurance companies are forcing existing doctors out of work.

"The overall problem is that primary care is reimbursed, not just by medicare, but by private insurers at a very low rate," said Dr. Wick Many of UAB Health Center Montgomery.

Plus, the act of preauthorizing testing leaves physicians like Dr. Temple hot under the collar.

"If a physician feels like the patient needs a CT scan or MRI, insurance should cover it. Now, you have to go through loops and hoops in order to get it," Temple said.

Those loops and hoops could get worse when the recently passed healthcare law takes effect and an additional 34 million patients enter the pipeline.

"Either we'll figure out how to serve, or we'll make waiting lists, unacceptably long for everybody-and the system collapses under its own weight," Williamson said.

It's a problem on the medical minds of tomorrow.

"It's great that more people are getting coverage, but the flip side to that is that you have less time with each patient, and that kind of reduces the quality of healthcare they may be receiving," explained third year student Nan Raghuraman.

Paired with a growing shortage of doctors to care for the state's population, mounting pressures just seem to be part of the job.

"I'd encourage any young person to go into primary care, because it's rewarding, you get to know your patients, you get to know their families," Temple said.

"It just gives you a feeling of accomplishment. Confidence that they have in you."

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