Side effects: Long waits, clinics over capacity, doctors stretched too thin, care rationing, more pressure on nurses 

Oct 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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