Michigan’s medical schools, doctors offices and health care networks are tackling a shortage of primary care doctors that is expected to worsen under the Affordable Care Act.
The state and nation have reported a shortage of primary care physicians for a decade, and the millions of newly insured patients are expected to add more pressure. In addition, health care reform is encouraging consumers to seek primary care more regularly to stay healthy and to keep on top of chronic conditions that can drive up costs.
“With health care reform, the shortage (of family doctors) may be bigger, and the estimate on that is all over the map,” said Dr. William D. Strampel, dean of Michigan State University’s College of Osteopathic Medicine.
Before the changes in health care laws, Michigan’s shortage was projected to reach 4,000 primary care physicians by 2025 and a 2,000-8,000 shortfall for all specialties by 2020, according to the Annals of Family Medicine.
It’s the perfect storm of an aging population needing more primary care, coinciding with a growing number of doctors retiring. Michigan has an estimated 29,800 physicians, with a quarter of them age 60 and older, according to a report prepared for Michigan Health Council and Medical Opportunities in Michigan.
Health care systems in Metro Detroit are expanding hours, adding staff and implementing creative approaches such as group medicine to accommodate the expected increased in demand for patient services.
Henry Ford Health System, for example, is keeping many of its medical centers open later and on weekends for both appointments and walk-ins, said Paul Szilagyi, vice president of primary care and medical centers.
“There is a great move to reduce emergency room visits, where patients end up after hours, so by extending our hours, that cuts down those ER trips,” Szilagyi said.
Henry Ford also is doing more group medicine; a room full of diabetics, for instance, may come together at the same time for doctor instruction and then break off for individual exams, which is a time saver, Szilagyi said.
The health care system has forged a partnership with CVS to offer clinics inside 14 stores, where nurse practitioners backed by doctors see patients for a variety of ailments, from strep throat tests to ear infections and other routine illnesses.
“We’ve also reinstated our Nurse On-Call program last year to save any unnecessary visits, cutting down on costs,” Szilagyi said. Registered nurses give non-emergency medical advice over the phone between 5 p.m. and 7 a.m., saving a trip to the ER or urgent care.
Providers to do more hiring
A long-term solution is to educate more doctors.
Vince DiBattista, president of the St. John Providence Physician Network, said the system is expanding access to after-hours urgent care and has two new facilities planned for Detroit’s west side.
St. John intends to hire more physician assistants and nurse practitioners to accommodate patients. It has the largest residency program in the state for primary care physicians, which has helped it maintain adequate staffing.
Royal Oak-based Beaumont Health System, meanwhile, is looking to add more primary care physicians.
“We have been expanding our primary care physicians at Beaumont,” said Colette Stimmell, a Beaumont spokeswoman. “(We know) that with more people having access to insurance through the exchanges and the Healthy Michigan Medicaid expansion, there will be a greater need for primary care.”
The Detroit Medical Center is preparing for an increased need for primary care, but “doing it with a sense of purpose and not panic,” said Chief Administrative Officer Conrad Mallett.
The seven-hospital system is conducting a physician manpower study to determine the community’s needs, while extending office hours for its resident primary care physicians.
The DMC is also working with Detroit’s Federally Qualified Health Centers, which receive government funding to provide basic services including primary care, urgent care, preventive care, mental health, dental, and vision.
“We want to be sure that we’re taking advantage of the community resources that are there, and there is a lot of opportunity to do that,” Mallett said. “We don’t think the primary care resources in the community are as small as some people say they are, and maybe they need to be better organized.”
Medical school class grows
MSU’s College of Osteopathic Medicine has doubled its medical school class, to 300 students, and Central Michigan, Western Michigan and Oakland University have opened or plan to open their own medical schools.
To extend its reach, MSU has added classrooms in Detroit and Clinton Township to complement the main campus in East Lansing, Strampel said.
Thanks to a $21 million grant, he’s added 85 residency slots in partnership with Detroit Wayne County Health Authority. Unlike in most residency programs, students will learn primary care medicine at the grassroots level, seeing patients in federally qualified health centers in Detroit, suburban Wayne County and rural Monroe County.
“Our goal is, if we train them in downtown Detroit, they’ll stay in downtown Detroit, which is an underserved primary care area in Michigan,” Strampel said.
Enticing students to choose primary care rather than a specialty is a challenge, said Dr. Dennis Tsilimingras, co-program director of MI-AHEC, a federal program at Wayne State University that aims to get more health care workers in underserved urban and rural areas.“The loan debt is high, often $200,000 upon graduation from medical school, so many are looking for a higher income to bring that loan repayment down,” he said. The salary for a family doctor ranges from $100,000 to $170,000 but specialties such as cardiology command much higher pay, Tsilimingras said.
Tsilimingras makes sure all his students know about the Michigan State Loan Repayment Program, funded by a federal/state/local partnership. MSLRP participants agree to provide full-time primary health care services in not-for-profit health clinics in underserved areas for two years. In exchange, the program pays a percentage of their student loans.
In the meantime, Michigan is getting help from other countries to minimize its shortage, said Deb Collier, director of recruitment services for the Michigan Health Council, which works to connect Michigan health care employers with practitioners. She often finds herself educating foreign medical students who attend Michigan medical schools on how they can remain here to practice.
Another way to get medical students working soon, said Dr. Edward “Ned” Canfield, a family doctor from Sebewaing in Michigan’s thumb, is to allow second-year residents to serve as primary care physicians in underserved areas.
“A resident who has completed one rotation has far more clinical and classroom experience than a nurse practitioner or a physician assistant,” Canfield said.
Technology may be another part of the solution, he points out. Telemedicine — talking to a doctor via phone or video conference — is a viable option for those in rural areas.
Dallas-based Teladoc Inc., the first and largest telehealth provider in the nation, serves several Michigan companies, including Herman Miller and Masco, which use its board-certified doctor service, said Teladoc CEO Jason Gorevic.
The companies encourage their employees to call for minor illnesses to fill the gap of access and contain costs. They wait approximately 16 minutes for a returned call with a typical copay of $40 or less, often having prescriptions sent directly to a pharmacy.
“Employers like it because it contains costs and boosts productivity,” Gorevic said. “Employees like it because they aren’t sitting in a waiting room, or driving to and from the ER, but they are quickly getting their needs met to get back to work. We think it’s a good solution for the physician shortage.”