The long-predicted shortage of primary care physicians facing this country, particularly in rural areas, has a much more urgent feel in Durango.
There, it is being called a crisis.
That’s because Valley-Wide Health Systems, a non-profit clinic serving thousands of area residents, closed its doors in March. The clinic couldn’t break even due to low Medicare and Medicaid reimbursements.
The Durango Herald reported in June that the closure means La Plata County is left with three full-time doctors available to provide care for about 13,000 low-income residents.
That sounds like a crisis to us.
What is happening in Durango is happening – or will happen – around the country. In Colorado and nationwide, about a third of practicing doctors are nearing retirement just as baby boomers reach an age where they’ll need more medical care. Meanwhile, the ranks of young people with aspirations to become general practitioners are sparse. Those who become general practitioners tend to prefer the employment and lifestyle opportunities of more urban areas.
“It’s so hard to find providers who are interested in working in rural areas,” said Lou Ann Wilroy, acting director of Colorado Rural Health Center.
The situation has prompted calls for medical schools to increase enrollment and for lawmakers to raise caps on federal spending for doctor training and to relax immigration rules that limit the number of foreign doctors.
A real solution, however, cannot avoid one of the proverbial third rails of American politics, and that is reform of the Medicaid and Medicare systems and health care provisions in general.
When doctors lose money on such patients because of low Medicare reimbursement rates, it is a matter of time before the health care system falls apart. Some would argue it already has.
Recently, Thomas Dean, a family doctor who has practiced in South Dakota for 30 years, was appointed to a federal advisory commission that makes recommendations to Congress about reimbursement rates.
Dean recently told American Medical News, a trade publication, that the financial viability of Medicare is fundamentally important to rural health care.
“We simply have to make the program stable financially,” he said. “It’s terribly important for the whole nation, but even more so for rural areas, because we have a higher proportion of elderly and disabled folks than the urban areas.”
However, Medicare and Medicaid are terribly expensive and are eating up the federal budget at an ever-increasing pace.
Peter Orszag, director of the Congressional Budget Office, told a Senate committee in June that if health care costs continue to grow the way they have over the last four decades, federal spending on Medicare and Medicaid will rise to about 20 percent of gross domestic product by 2050. In 2005, it was less than 5 percent.
The federal budget picture provides a broader context that helps explain why it is so difficult to coax young people to become doctors and provide services in places where a big percentage of their patients are Medicare and Medicaid.
In Durango, the city and county have hired a consultant in the hopes of finding short-term solutions to their health care shortage. U.S. Rep. John Salazar, D-Manassa, worked to put $200,000 for a health care clinic into a federal appropriations bill that still is pending. And he and his brother, U.S. Sen. Ken Salazar, succeeded in having the county receive a federal health care shortage designation, making La Plata doctors eligible for Medicare bonus payments and other incentives.
It appears that some help is on the way for the Durango area, but next it could be any of a number of rural areas that finds itself with a paucity of doctors. The only way to have a shot at comprehensively solving these problems is for federal lawmakers to take on the thorny issue of national health care reform. It is a complicated matter that poses many difficult choices, but the need is inescapable.
