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50 million new patients? More primary docs a must

Associated Press | 9/16/2009, 4:39 a.m.

The society also found a drop in the number of primary care doctors accepting new patients. In 2008, 42 percent had closed their practice to new patients, compared with 33 percent in 2004, before the law was signed.

Part of the problem is that those trained to intervene after a heart attack typically earn more than those who help prevent the heart attack from happening in the first place, said John Auerbach, the Massachusetts Medical Society’s immediate past president.

“We have devalued the work of what a primary care physician does,” he said.

Epperly, of the American Academy of Family Physicians, said primary care doctors need a 30 percent pay increase. The average family doctor makes about $160,000 a year, he said. A 30 percent increase would bring them over $200,000, compared with the average $300,000 for a specialist, he said.

When Dr. Robert Flaherty launched a private practice in 2001, he soon found himself cramming in as many patients as possible to make ends meet, leaving little time to discuss with them the steps they could take to prevent future health troubles.

“I constantly felt that conflict of going faster than I should,” said Flaherty, 40, who gave up his practice after four years for a hospital post. “Everyone knows — if you want to make a decent living, become a specialist; if you want to be banging your head, go into primary care.”

Massachusetts is trying to expand access to primary care by encouraging doctors to adopt a team approach by relying more heavily on nurse practitioners and health educators for basic care and counseling, said Massachusetts Health and Human Services Secretary Dr. JudyAnn Bigby.

Nurse practitioners already figure prominently in the operation of private clinics set up in pharmacies, offering basic services like flu shots and treatments for minor ailments. CVS Caremark Corp. and Walgreen Co., which operate hundreds of the clinics around the country, say they are faster than a visit to a primary care doctor and less expensive than a trip to the emergency room.

The state also offers loan repayments of up to $75,000 for new doctors who agree to work in community health centers for three years. So far, 70 new doctors have signed up.

Another way to expand primary care is to have some specialists provide the equivalent of primary care, according to Dr. Georges Benjamin, executive director of the American Public Health Association.

He said obstetrician-gynecologists essentially serve as primary care physicians for many women — a model that could be used for patients who rely on other specialists.

Ryan Van Ramshorst is the kind of young primary care doctor that advocates say the country needs to fill the gap. A fourth-year medical student at Baylor College of Medicine in Texas, Ramshorst is doing his residency in general pediatrics.

“When I wrote on my medical school application that I wanted to help people, I really meant it,” he said.

The federal National Health Service Corps, the same program that helped Regina Benjamin, is helping him, covering two years of his tuition and expenses in exchange for him spending at least two years in a clinic in an underserved area.

Ramshorst said he’s thankful for the opportunity, but said plans to expand the corps — the Obama administration has announced $200 million in federal stimulus funds to boost the corps by 3,300 doctors and clinicians — is no replacement for adding more primary care doctors and increasing pay.

“We need something with a bigger scope,” he said.

(Associated Press)