When health care reform begins to take effect in Connecticut, it will undoubtedly mean insurance for tens of thousands of people who have lacked coverage. But that doesn't mean they will be able to find a doctor to see them.
The Connecticut State Medical Society is warning of a major shortage of primary care physicians in the state that, if not addressed soon, will lead to longer waiting periods for patients or a lack of access to doctors for the newly insured.
According to a survey by the medical society, which polled 498 doctors, 28 percent of internists and 26 percent of family physicians said they already are not accepting new patients.
Additionally, new patients have to wait an average of 18 days for a routine office visit, while existing patients have to wait 16 days to see a pediatrician or 15 days for an internist.
The results confirm Connecticut's primary-care capacity is already stretched thin.
The addition of thousands of newly insured patients will make the problem worse, especially in rural areas, if structural issues are not addressed, officials said.
"A lot of people think they may have access, but they are not going to be able to find a physician to take care of them," said Dr. Douglas Gerard, an internist who runs a one-man shop in New Hartford. "They are increasing the demand side of patients, but didn't increase the supply side of physicians."
Gerard, who is the only practicing doctor in town, said he already has about 2,200 patients, with little to no room to add more. He typically sees about 15 to 20 patients a day, each for 15 to 45 minutes. He said he hasn't been able to take on a new Medicare patient in at least three years and he's stopped seeing Medicaid patients because of the poor reimbursement schedule.
The only way he'll be able to see new people is if he shortens visit times, something he's not willing to do.
"I don't have room for more than I'm already seeing now," Gerard said.
In Hartford County, it's estimated that 13.4 percent of the 544,000 individuals between the ages of 18 to 64 are uninsured. Most of them are expected to get coverage under both state and federal health care reform initiatives, according to Matthew Katz executive vice president of the state medical society.
That means of the approximately 531 physicians in the region that currently provide primary care, they will each need to add at least 137 new patients. But since nearly 23 percent of those doctors aren't adding patients, the average physician that is would need to add 179 patients.
In Litchfield and Tolland counties, there will be an average of 283 and 424 new patients per doctor respectively.
The average Connecticut doctor has about 2,000 to 2,500 patients, Katz said.
The primary care shortage is a result of many factors, Katz said. Fewer medical students are going into the field because primary care doctors are paid less than specialists. The huge debt load medical students carry after they graduate adds pressure to go into the highest paying practice areas.
Katz said there are also relatively few health insurers in the Connecticut market, putting physicians at a disadvantage in terms of trying to negotiate better fee schedules.
Medical liability is also a huge problem. Katz said Connecticut has some of the highest liability rates in the country because the state has failed to tackle tort reform in any meaningful way, leading to defensive medicine practices by physicians who are forced to pay huge insurance premiums.
Gerard said he pays about $20,000 annually for his medical liability coverage.
Primary care doctors also say they are drowning in paperwork. In many cases physicians are forced to hire more administrative assistants than clinicians.
About 25 percent of family physicians and 22 percent of internists surveyed by the medical society said they were contemplating a career change because of the practice environment in Connecticut.
Katz said his organization is urging lawmakers to adopt a loan forgiveness program for primary care physicians who agree to practice in Connecticut. He also said tort reform needs to be tackled as soon as possible to ensure that frivolous claims get thrown out quicker.
Ellen Andrews, the executive director of the Connecticut Health Policy Project, is also a member of the Sustinet board's work force task force, which is exploring ways to fix the medical personnel shortage in the state.
The board was created last year as part of the passage of the Sustinet bill, which aims to create universal health care in Connecticut. Members haven't reached a consensus yet, but are considering multiple ideas. They are supposed to present their findings to lawmakers in July.
Ideas being discussed include establishing scholarships for those seeking a career in primary care, instead of a loan forgiveness program. The idea, Andrews said, would be to provide students money upfront.
There may also be an attempt to encourage physicians to join larger practices so they can share administrative burdens.
Gerard, for example, is a member of Collins Medical Associates, an organization affiliated with St. Francis Hospital, which is in charge of doing his administrative chores like handling billings.
Andrews noted that provisions in the federal health care reform law could help with some of Connecticut's problems.
Beginning in 2011, for example, primary care providers will be eligible for a 10 percent Medicare bonus payment, and starting in 2013 and 2014, Medicaid payments for all primary care service will be brought up to equal Medicare payment rates.
The state will also need to go after money set aside in the health care law for pilot projects that aim to increase the ranks of physicians and other medical care providers, Andrews said, because nurses and pharmacists are in short supply too.