Primary care doc shortage epidemic

It is heard and read frequently that Louisiana has a shortage of primary care physicians, but what exactly are primary care doctors?

The quick answer is primary care physicians are what were formerly called family doctors, and, more recently, general practitioners. The even quicker answer is that they are doctors who take a broader concern about a patient’s health.

The Louisiana Interagency Task Force on the Future of Family Medicine, which was created by the Louisiana Legislature in 2004 to put forth “strategies to eliminate the significant health care shortage in the state” has a more concrete definition.

The task force stated in a recent report, “Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern … not limited by problem origin (biological, behavioral, or social) …”

Family Medicine, it said, is “a specialty in breadth that integrates the biological, clinical and behavioral sciences.”

Primary care physicians are needed more commonly in rural areas because persons in and around urbanized locations have greater access to medical specialists.

According to the task force report, “Family physicians are the medical discipline … best suited for the diversity of services required in rural practice, and by far the most likely … to enter rural practice.”

“Louisiana is a rural state,” said Paul Landry, regional administrator with the Louisiana Office of Public Health Region 3, which includes Lafourche and Terrebonne Parishes.

“Most of our parishes are rural,” he said. “They’re experiencing a shortage of primary care physicians.”

The federal government classifies a region as a Primary Care Health Professional Shortage Area if more than 3,000 persons live in an area having only one primary care physician.

About 20 percent of the U.S. population reside in Primary Care Health Professional Shortage Areas, but “81 percent of Louisiana can be classified as a Health Professional Shortage Area,” said Stacy Fontenot with the Louisiana Rural Health Association in Napoleonville.” The task force pegs the figure at 97 percent.

“I think Louisiana could benefit from more primary care physicians,” she said. “We have a lot of poor populations that tend to use emergency rooms. More primary care physicians would cut down on use of emergency rooms.”

Camille Turner, with the Bureau of Primary Care and Rural Health in Baton Rouge, said that the federal government classifies Lafourche Parish as a Primary Care Health Professional Shortage Area.

Lafourche is 10 primary care physicians short of meeting the federal standard, she said.

Milton Bourgeois, CEO of Ochsner St. Anne General Hospital in Raceland, said that the hospital is seeking to hire seven more primary care physicians.

The hospital currently has nine on staff.

“We’re coping OK” with the shortage, Bourgeois said.

The hospital expects to hire another primary care physician within a year-and-a-half.

“It’s tougher to fill post-Katrina,” he said. “They have a fear of the big storm.”

“There’s a shortage of health care workers overall,” he said. “There’s a big demand nationwide for primary care physicians.”

Because Chabert Medical Center is located there, north Terrebonne Parish satisfies the federal standard, but southern Terrebonne is 1.4 primary care physicians short of the federal benchmark.

Christie Nichols, with the Louisiana Bureau of Primary Care and Rural Health, said, “Obviously, people in communities without primary care physicians have limited access to health care. They don’t seek care at all, or they go to emergency rooms, which can be inappropriate.”

“The supply of physicians is critical,” she said. “Louisiana is underserved with primary care physicians. That means longer wait lines. Physicians are overworked. There’s the quality of life (issue) for physicians.”

Turner said, “It’s a big problem. Patients may need to go far away if they have no insurance.”

Louisiana’s medical schools produce an ample supply of physicians, just not primary care ones.

The state ranks 10th in the nation in per capita production of doctors, but 38th for primary care physicians.

To combat the shortage, the state offers to pay off the school loans of students, in exchange for them committing to work in Primary Care Health Professional Shortage Areas in Louisiana.

“We have incentive programs to help recruit primary care physicians,” Turner said.

The federal government offers similar loan repayment programs to students intending to work in shortage areas.

But, “even with these programs in place,” the task force report states, “Louisiana’s historical difficulty in filling its Family Medicine residency slots with instate or out-of-state students remains a concern.”

The report says that medical schools in Louisiana have directed only a small part of graduates into Family Medicine training since 1980.

From that year until 2006, “9.5 percent of all Louisiana medical school graduates, or an average of 38 students a year, entered Family Medicine residencies,” the report states.

And many of those went into residencies outside Louisiana.

The task force recommended exposing more students to Family Medicine during each year of medical school.

Paul Butler, the acting CEO of the LSU Health Care Services Division, spoke to the Bayou Industrial Group in Thibodaux on Aug. 6 about the status of public health in Terrebonne and Lafourche Parishes, and in Louisiana as a whole.

Chabert Medical Center has a Family Practices division.

The South Louisiana Medical Associates recently donated $200,000 to the Chabert Medical Center Foundation to help fund the new Internal Medicine Residency Program at the hospital beginning in 2008.

Internal Medicine is similar top primary care because the former involves non-surgical treatment of disease.

Butler called the shortage of primary care physicians in Louisiana “a below the radar crisis.”

“Most people know little about the public health system,” he said.

“We’ve let other people define us, partly because we’ve been paddling to keep ourselves above water,” he said.

Charity and the Dept. of Veterans Affairs Hospital in New Orleans closed permanently after Hurricane Katrina.

“Every one of our (public) hospitals (in Louisiana) does 100,000 outpatient visits a year,” he said.

Chabert, in recent years, has acquired the capacity to perform angiograms and heart procedures, which patients would have had to find elsewhere formerly.

“We look at what other people are doing, and if there’s a gap, we close it,” Butler said.

“I’ll never accept, ‘It’s good for poor people,'” he said. “Louisiana is a needy state. We need to stretch every dollar we can. If we can do it cheaper, then support us.”

State Sen. Reggie Dupree liked the quality of care he received at Chabert in 2005 after his intestines ruptured following gastric bypass surgery.

“They saved my life 21 months ago,” Dupree told Butler. “The care was excellent. I would recommend that anyone go there.”