East Alabama feels pinch of doctor shortage

By Brittany Whitley

Published: June 21, 2008

Need a doctor? So does everyone else.

Along with the rest of the country, the Opelika-Auburn area has a shortage of primary care physicians.

The lack of primary care practitioners stems from a build-up of circumstances that have compounded into one large problem — too many patients, not enough doctors.

“I’ve got people calling every day that we turn away. This is an issue,” said Dr. Michael T. Gunter, an internist at Internal Medicine Associates. “We’re having to turn away a lot of people, which we hate.”

One part of the problem is that Baby Boomer doctors are reaching retirement age and leaving their practices, Gunter said.
Another is that the general population is getting older, too, and people are living longer. Those people are in need of primary care
physicians.

“There are more medical problems being managed,” Gunter said, referring to an older population with medical issues and chronic illnesses that need constant monitoring.

A third factor is economics.

Medical school graduates have large student loans to pay off. Many recent graduates go into specialty medicine, which pays more, as opposed to primary care.

“There is a significant discrepancy in income,” Gunter said. “The economics are driving it from that end.”

There’s not a surplus of specialists, Gunter said, just too few primary care physicians.

Instead of it being 50-50, with 50 percent of medical school graduates going into general practice and 50 percent deciding to specialize, it is 80-20, with 80 percent specializing, he said.

Lifestyle also comes into play, Gunter said.

Specialists usually work fewer hours and there is more prestige associated with specialty medicine, he said.

The problem does not have an easy fix, he said.

For the first time in more than two decades, medical schools are increasing the number of students admitted.

But still it takes six or seven years of schooling to produce a doctor, Gunter said.

The playing field has to be leveled between specialist and primary care physicians in terms of pay and other issues, he said.

Dr. Michael J. Lisenby, vice president of clinical affairs at East Alabama Medical Center, agreed there is a problem.

“(There is) a shortage of supply (of doctors) and an increase in demand, especially in our community,” he said. “Lee County is projected to increase in size 25 percent between 2005 and 2015. That’s 30,000 people. … We’re short 15 primary care physicians (now). If this continues, by 2015 we may need as many as 35.”

Insurance reimbursement also plays a part in the doctor shortage in Alabama.

“Physicians’ incomes are based on reimbursements,” he said. And reimbursements are based on medical procedures.

Unlike specialists, primary care is not procedure-oriented field, he said.

So, primary care physicians may not receive as much money from insurance companies as specialists.

Another problem is insurance reimbursement is higher in other states — as much as 15 to 20 percent higher, he said.

Doctors are therefore attracted to states with larger insurance reimbursements, where it is possible for them to make more money, he said.

Patients probably will not have a problem getting into an urgent care clinic for acute aliment, he said, but older people need a regular doctor.

“Who’s going to take care of those folks?” he said.

Both Lisenby and Gunter advocate contacting Congress about the problem, but Lisenby had additional advice.

“Start with basics, with understanding. Become more aware with reimbursement issues,” he said. “Have an awareness.”

Communicate with insurance companies and legislatures, he said.

Jim Brown, senior vice president of customer relations and information services for Blue Cross and Blue Shield in Alabama, said he is aware of the problem.

“I think everything you see and read is that medical schools are having a hard time getting students to stay in primary care,” he said. “As physicians come into the state, we try to get them in our preferred medical doctor program (PPO) as soon as possible.”

Blue Cross and Blue Shield does not recruit physicians, he said.

One of the things Blue Cross and Blue Shield is trying to do is encourage people to take better care of themselves through its Healthy Living Web site, Brown said.

The Web site is there to try to relieve pressure on the healthcare system, he said.

Brown said some patients go to a specialist when it’s unnecessary.

Brown recommends that people seeking a doctor get someone who meets their medical need, not their insurance need.