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Medical Survey Results Show Health Reform Will Overburden Connecticut Doctors

By ARIELLE LEVIN BECKER

April 15, 2010

HARTFORD —

Health care reform is poised to increase the number of people with health insurance, but the newly insured may have a hard time finding a doctor, according to a survey of primary care physicians by the Connecticut State Medical Society.

The survey, released Tuesday, found that 28 percent of internists and 26 percent of family physicians are not accepting new patients. Those who are taking new patients often have waiting periods of more than two weeks before a patient can get in to see the doctor for a routine visit.

Accommodating people who are now uninsured would stretch the state's primary care practices even thinner, increasing patient loads by 7 percent to 20 percent, according to the medical society.

"Against the backdrop of a dramatic expansion of health care coverage, Connecticut already has a scarcity of access," said an article detailing the survey, which will be published in the May issue of the journal Connecticut Medicine.

The article warns that the potential load of new patients from federal health reform and the state's SustiNet health care law "may be difficult to manage for primary-care physicians in urban areas, and could overwhelm physicians in rural communities."

At a press conference Wednesday, medical society leaders and members suggested that the state consider incentives to lure primary care doctors to practice here, offer loan forgiveness for medical students who pursue primary care and consider changes to ease the liability and administrative burdens doctors face.

The report also noted dissatisfaction among doctors. A quarter of family physicians and 22 percent of internists said they were considering a career change because of the "practice environment in Connecticut," the survey found. Pediatricians reported more satisfaction.

Matthew C. Katz, the medical society's executive vice president, said having an adequate supply of doctors will be critical to the success of health care reform.

Most of the discussion about reform centered on providing health insurance to more people, Dr. Robert McLean, a New Haven internist and rheumatologist, said during the press conference.

"Insurance being provided is not access to care," he said.

Instead, he said, without an increase in the number of doctors to treat the newly insured, more people will fill emergency rooms, an inefficient way to deliver care.

McLean illustrated the administrative burdens doctors face by describing his day at work Tuesday: He saw 22 patients, many of whom were having follow-up visits for hypertension or diabetes.

One patient with a lingering headache came in concerned about a brain tumor, and McLean said he spent time explaining why a test would not be necessary — one way that primary care doctors can cut down on overuse of medical services, he said.

Between patient visits, McLean returned to a desk covered in piles of paper, including 25 faxes about patient refills he had to sign and authorization requests for medications for other patients. For another patient, who needed an MRI, McLean filled out paperwork, while his assistant later spent time on the phone to the patient's insurance company explaining why the MRI was necessary.

McLean said the system could be simplified by adopting a "patient-centered medical home" model, in which all of a patient's care is coordinated, often through a primary care doctor.

That will require systemwide change, which will take time, he said.

"In the meantime, I hope that policymakers will take notice before physicians like me decide that they've had enough of it and they leave the profession," he said.

The survey included 498 Connecticut primary care doctors, 23 percent of those solicited. The research was funded by the Universal Health Care Foundation of Connecticut.