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Study: County faces primary care shortage

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Primary care physician Andy Houston updates a patient's records following an exam Tuesday at Johnson Memorial Hospital in Franklin. Johnson County has 92 primary care physicians.
Primary care physician Andy Houston updates a patient's records following an exam Tuesday at Johnson Memorial Hospital in Franklin. Johnson County has 92 primary care physicians. PHOTO BY SCOTT ROBERSON

Johnson County has fewer primary care doctors, nurses and physicians assistants than other central Indiana counties and should have more, a study found.

A study by the Indiana University School of Medicine found that the county falls short of a national standard for primary care providers and also lags behind 12 other counties in the state. However, Johnson County is close to having the amount of primary care providers that’s considered adequate and isn’t in crisis like many of Indiana’s rural counties, researchers said.

Primary care providers, including physicians, physicians assistants and nurse practitioners, are in short supply nationwide, and shortages are projected to get worse. An aging population, rising rates of obesity and diabetes, and the new federal health care law all are expected to increase the demand for primary care, according to Dr. Richard Kiovsky, director of the Indiana Area Health Education Centers Network and a professor of clinical family medicine at IU.

Shortages could result in longer waits to see a doctor, physicians not being able to accept new patients and less accessible health care, Kiovsky said. People might put off doctor visits and later have to go to emergency rooms, driving up the costs for everyone. Overworked doctors might struggle to keep up and be sloppier in their work.

One local health care provider estimates that the county needs dozens more primary care physicians, and the need will grow over the next five years. But their ranks have been dwindling nationally as medical students pursue more lucrative careers in specialized medicine. Health officials have been trying to address that problem, such as by launching a new medical school at Marian University and boosting enrollment at the Indiana University School of Medicine by about 25 percent.

Community Health Network has determined there currently is a shortage of more than 40 primary care physicians in Johnson County, and that will worsen over the next five years, said Gwen O’Malley, executive director of primary care for Community Physician Network.

O’Malley said Community Health Network wants to address that need. Plans call for adding four primary care doctors this summer at the new medical office building on State Road 135 in the Center Grove area that is being developed with Johnson Memorial Hospital and as many as 15 at that location in the next few years.

The demand for family doctors, obstetricians and other general practitioners will only increase over the next few years, especially after the new federal health care law increases the number of patients who can get primary care, O’Malley said. The health network’s studies found that Johnson County will need at least 67 more primary care doctors by 2017, she said.

“Certainly, Community is very much invested in Johnson County,” O’Malley said. “We want to get more physicians as quickly as we can. You’re going to see a vivacious growth model over the next five years and a much larger presence for Community in Johnson County.”

Community has been working to recruit more primary care physicians to the area and plans to open more doctor’s offices.

Johnson Memorial Hospital expects that a few more primary care physicians will be based out of the new office at Stones Crossing Road and State Road 135, chief development officer Bill Oakes said. The hospital continually reviews whether there’s a need for more physicians and added new primary care doctors a few years ago, he said.

The 2012 Indiana University School of Medicine study found that Johnson County had 92 primary care physicians, physician assistants and nurse practitioners for every 100,000 residents. The national standards recommended by the Robert Graham Center is 100 primary care clinicians for every 100,000 residents.

That’s the amount that’s generally considered to be necessary to adequately meet the health care needs of a community, said Dr. Terrell Zollinger, a professor of epidemiology at the IU School of Medicine who worked on the study.

Several other central Indiana communities have far more primary care providers than the recommended minimum, the study found. Hamilton County has 213 clinicians per 100,000 residents, while Hendricks county has 112 for every 100,000 residents.

“Johnson County hasn’t attracted as many physicians as the northside because for 15 or 20 years it’s been perceived as the place that’s up and coming, with a plethora of restaurants, housing options and top-rate school districts,” O’Malley said. “But Johnson County has raised the bar and begun to compete for the physicians we recruit. We hear that they grew up on the southside, have family on the southside and want to stay in and practice on the southside.”

Johnson County is ranked 13th in the state in the number of primary care providers in relation to population and 12th in the number of primary care doctors, the study found. The county has 71 primary care doctors per 100,000 residents, which is less than half as many as Hamilton County but higher than the state average of 38 physicians per 100,000 residents.

Rural counties suffer most, Zollinger said. People who live in rural areas, including southern Johnson County, often have to drive great distances to get primary care.

That’s a problem because it can lead many people to put off getting care they need, Kiovsky said.

“If someone’s running a fever and all the clinics in southern Johnson County are busy, it might be a real hassle and not worth it to them to go up to Indianapolis to see a doctor,” he said. “They’ll try to tough it up and hope it clears out on its own.”

But that flu could get worse and they might later have to get more costly treatment at an emergency room, since they never got primary care, he said.

Primary care keeps health care costs down through prevention, but won’t be as accessible if the number of physicians practicing it continues to shrink, he said.

The problem could affect all communities, including the suburban ones that primary care doctors typically flock to, as the population ages, Kiovsky said. People older than 65 see primary care doctors twice as often as younger people, and that can put a strain on the system.

In addition, fewer medical students have been choosing to go into general practice because they can make far more money as a specialist, he said. Specialists generally have more income because insurance companies pay them more when they use advanced technology such as endoscopies or heart catheterizations.

Compensation for primary care doctors has lagged, Kiovsky said. A new doctor faces the choice of making $125,000 a year as a primary care physician or $300,000 a year as a specialist.

“They might get paid a lower rate to provide the kinds of care they’d like to,” he said. “The economics of it makes it a real tough choice.”

Students leave medical school with $168,000 or more in debt and often have to take the higher salary, he said.

Health officials are addressing the problem, including boosting enrollment at the Indiana University School of Medicine and encouraging rural school systems to do more to promote careers in medicine, which many of their students don’t consider as an option.

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