Data Show NY Need For Primary Health Care Doctors


surgNew York’s medical community worries that adding 1.1 million people to insurance rolls under the federal health care overhaul will overwhelm primary care physicians, many of whom are already swamped.

Federal data showed nearly 18,000 physicians providing primary care at the start of 2011 in a state with 19.6 million residents. That was the 11th-best ratio among states.

The New York Department of Health estimates that 2.7 million people are uninsured, and that 615,000 individuals and 450,000 small-business employees will enroll through the New York Health Exchange for coverage starting in 2014.

Medicaid, the government health insurance program for the poor, now covers 5.1 million New Yorkers and is expected to add about 75,000 more under an expansion of the program that’s part of the federal Affordable Care Act.

Dr. Alan Diaz, an internist and past president of the Bronx Medical Society, said his practice, with a new partner and part-time physician’s assistant, has 6,000 patients.

“Primary care in New York is already at crisis level,” he said. “When we get another million insured, I tell my residents, colleagues and patients, there will be no physician in New York to serve them.”

“The clients, the patients, I estimate in the next five years their health care will actually be at the hands of a midlevel practitioner,” said Diaz, a native of Puerto Rico who began his private practice in the Bronx 20 years ago.

Family practice physicians can finish school with $250,000 of debt and can earn as little as $30 an hour on complicated cases because of low reimbursement rates. They face increased competition from hospital physicians and from lesser-trained nurse practitioners and physician assistants, and have to pay for high malpractice insurance rates, computers and support staff. Costs are higher and reimbursements lower in New York, driving many doctors elsewhere after training here, while many physicians opt for higher-paid specialties, Diaz said.

“Primary care physicians are at the forefront of a physician shortage that continues to worsen in New York state,” concluded the 2012 physician workforce survey of the Healthcare Association of New York State, which represents hospitals. The group noted that of more than 1,200 physicians needed statewide, 374 were in primary care.

Federal data already identify about 4 million New Yorkers living in underserved areas, mostly in poor city neighborhoods and remote rural areas.

The Healthcare Association survey acknowledged ongoing state-funded programs intended to help reach those patients and notes that medical schools nationally are expanding enrollments gradually to meet growing demand.

The survey also noted the trend toward hospital employment, where more than half of practicing physicians have gone, and that New York is the physician training capital for the country, with more than 16 percent of the nation’s doctors completing residencies here.

Associated Medical Schools of New York said this year about half of 2,160 graduating medical students will stay in the state for their residencies. Enrollment at the 16 schools has increased 14 percent over the past decade and several of the schools plan to increase class sizes or launch programs to train doctors for underserved, rural areas.

The Medical Society of the State of New York, which represents doctors, has continued to urge lawmakers to make New York more hospitable by limiting liability costs and increasing Medicaid payments for services. Under the federal overhaul, those payments are supposed to rise from 60 percent to 100 percent of the federal Medicare rates starting this year, but that only lasts two years and hasn’t started yet, said society Senior Vice President Elizabeth Dears.

“We need to assure physicians and non-physicians are paid adequately for the services they deliver,” Dears said.

The New York health department’s 2013-14 budget includes $8.5 million for programs putting physicians in underserved areas, spokesman Bill Schwarz said. Doctors Across New York began in 2008 and has awarded $8.9 million to support practices and $7.6 million for loan repayments.

State officials are also seeking federal Medicaid waivers for another $250 million to expand the program.