February 2, 2009

The primary care shortage

Posted at 4:16 PM by Adam Linker

Stories in the news over the weekend highlighted the fact that North Carolina’s population growth is outstripping the number of dentists we are producing. Also, low Medicaid reimbursement rates are causing serious access problems, especially in rural areas. Four counties — Camden, Gates, Hyde, and Tyrrell — have no dentists.

But equally alarming is the lack of primary care physicians in our state as the new North Carolina Health Statistics Pocket Guide 2007 shows (hey, you never know when you might be traveling and wish you had some health statistics in your pocket).

In addition to not having any dentists, Tyrrell County does not have any primary care docs. And other counties are woefully lacking in general practitioners too. Gates County has 11,819 people for every primary care doctor. Camden County has 9,519 residents for each doc and Warren County has 9,960 people for every physician.

The North Carolina Institute of Medicine has offered some good suggestions for boosting the supply of primary care physicians in North Carolina. Unfortunately, the state’s initiative to increase enrollment at the UNC and ECU medical schools and allow students to study for two years in Charlotte and Asheville is now on hold.

In reforming health care, we will have to do more than just train more doctors. Incentives will have to shift to pay primary care doctors more so that more students will want to be general practitioners instead of specialists. In creating a system of better coordinated care, primary care physicians will be critical. We will need to pay them to listen to patients, to take phone calls, to check email.

Perhaps as a state we could help hospital systems like University Health Systems of Eastern North Carolina or Mission Health System in Asheville create family practice clinics that are paid per patient instead of individual payments for each treatment. Other states have had some success with this model. Community Care of North Carolina already works in a similar fashion with Medicaid patients.

It is clear that coordination of care and more general practitioners are key to building a better health system and controlling costs. North Carolina needs to take action to help its citizens in rural areas where doctors are scarce; in the process we could put our state on the cutting-edge of health reform.

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2 Comments

2 Comments Add yours »

Imee 3 Feb 2009 3:38 am

there is health care shortage and yet people keep opposing this part of the economic stimulus package. weird!

Polly Williams 5 Feb 2009 10:38 am

Shifting a lot of primary care to physician’s assistants and nurse practitioners could lower costs and alleviate the shortage of primary care doctors without lowering the standard of health care.

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