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Side effects: Long waits, clinics over capacity, doctors stretched too thin, care rationing, more pressure on nurses
BY SARAH TOMPKINS
sarah.tompkins@nwi.com | Tuesday, October 18, 2009
 Dr. Jon Van Roo starts each day of his
medical residency program with a Starbucks
coffee. He puts on a white coat embroidered
with his name in purple stitching and and
works up to 11 hours, six days a week,
in the emergency room at the Methodist
Hospitals Northlake Campus in Gary. During
intensive care and trauma rotations, he puts
in 27-hour shifts every four days.
"We
work some really odd hours," said Van Roo,
37, a Northwestern University resident. "Our
shifts sometimes go around-the-clock." Van
Roo, like other medical students, will train
between seven and 15 years, depending on the
specialty, before becoming a full-time,
licensed physician.
It takes about a decade to produce a new
doctor, said John Gorski, chief operating
officer of Munster's Community Healthcare
System. And the United States is facing an
impending doctor shortage -- of as many as
120,000 physicians by 2025, according to the
Association of American Medical Colleges --
and the concern is whether the physician
population can treat an impending influx of
more patients when it already is stretched
thin. Gorski said most of Community's
physicians are in their 40s or 50s, and
they, like many others nationwide, will
retire in the next 15 years. Compounding
this picture, fewer residents are becoming
general, family and emergency room doctors.
With the number of insured patients
expected to grow with any health care
expansion approved by Congress, experts
worry there will be even more demand on a
dwindling supply of doctors. Meanwhile, the
graying of the Baby Boom generation will put
added pressure on the system.
"I think we are all going to be in
trouble," Gorski said. "We deal with
capacity problems now. Community (Hospital
in Munster) is full all the time, St. Mary's
(Medical Center in Hobart) is full all the
time. St. Catherine's (Hospital in East
Chicago) isn't always full because the
population is less over there, but they've
significantly increased."
Since 1997, the number of medical
students going into primary care, which
includes general, family and internal
medicine, has dropped by more than half,
according to the American Academy of Family
Physicians. And 75 percent of emergency
department medical directors report
inadequate on-call coverage, according to
the American Academy of Emergency
Physicians.
"The utilization rates of the baby
boomers ... is going to increase, which is
going to require more doctors and more
capacity in hospitals," Gorski said.
Lauren Dvorscak, a third-year medical
student at Indiana University School of
Medicine-Northwest, said she was surprised
to see that some doctors treat about 30
patients each day.
"It was overwhelming from my standpoint
as a student learning," Dvorscak, 25, of
Highland, said. "There's definitely a doctor
shortage."
But there's also a benefit. Dvorscak said
these large numbers of patients give medical
students such as her great opportunities to
do a variety of clinical work.
Because of the doctor shortage, which is
expected to worsen, the Association of
American Medical Colleges has called for
medical schools to increase enrollment 30
percent by 2015. Most schools, including
Indiana University, are accepting more
medical students each year and are expanding
programs.
 The U.S. Department of Health and Human
Services reports the number of physicians
nationally has increased since 1980 and is
expected to continue increasing through
2020, according to Dr. Holly J. Humphrey,
University of Chicago professor and dean for
medical education. She said the school has
decreased class size while keeping the same
amount of scholarship money available to
help students offset their debt.
"It's an important change that will
hopefully encourage more students to pursue
medicine who are frightened by that debt
burden," Humphrey said.
Students like Dvorscak can pay as much as
$200,000 for medical school. Residency
programs on average pay about $45,000 a year
to residents, Van Roo said, making it hard
for doctors to pay back loans while
completing their multiyear programs.
Dr. Alex Stemer, president and CEO of
Medical Specialist Centers of Northwest
Indiana, said doctors are getting paid less
now than in the past because of low Medicare
and Medicaid reimbursement rates that do not
cover the cost of providing care. Stemer
said this lower pay makes it harder for new
doctors to pay off loans.
"You enter practice as a doctor with
typically a quarter of million (dollars) in
debt," Stemer said. The Association of
American Medical Colleges estimates most
students left medical school last year with
more than $150,000 in debt, an increase of
11 percent from the previous year.
With health care reform a possibility in
Congress, the question for many health care
providers is how many more physicians will
be needed to care for the U.S. population.
"The fact is that if you do increase
coverage, there is eventually going to be an
increase in demand," said Dr. Pat Bankston,
director of Indiana University School of
Medicine-Northwest. "Without an increase in
health care providers, then you're
guaranteed to slow down care. This is the
whole idea of waiting in line and rationing,
because you don't have the providers to take
care of you."
Stemer agreed, adding the current federal
health care reform legislation increases
access for Americans without increasing
capacity.
"The president wants everyone to have an
insurance card and make an appointment,"
Stemer said. "The president is thinking
they'll go to the office instead of the
emergency room when they need care. So now
what is going to happen when the (doctors')
schedules fill up?"
Dvorscak and Van Roo said they know what
they will face.
"I think in the past (medicine) was a
well respected profession, and I hope it
stays that way, because we're really
privileged to be able to do what we do," Van
Roo said. "I think it's a hard job, but it's
a really good job."
Nurse practitioners could be the new face
of primary care
Nurse practitioners can perform most of
the same functions as a doctor -- and with
fewer doctors becoming general
practitioners, many nurse practitioners now
are acting as primary care physicians.
"We're never educated to do surgeries,"
said JoEllen Wynne, family nurse
practitioner and associate director of
education for the American Academy of Nurse
Practitioners. "But I've done suturing,
assisting with chest tube insertions, and
(other nurse practitioners) put in central
lines in the intensive care unit and they
sew patients up."
A nurse practitioner is a registered
nurse who has a master's or doctorate
degree. These degrees include specialized
training in areas such as prescribing
medications and diagnosing and treating
conditions. Nurse practitioners typically
have at least six years of education and
many more years of clinical experience.
Nurse practitioners are educated at
national standards and are nationally
certified, but each state has different
rules as to what nurse practitioners can and
cannot do, Wynne said.
Nurse practitioners, by the numbers
1996 50,000
2001 82,000
2006 115,000
2009 125,000
Source: American Academy of Nurse
Practitioners
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