Effingham Daily News, Effingham, IL

July 1, 2013

Some optimistic despite doctor shortage concerns

Bill Grimes Daily News
Effingham Daily News

---- — Effingham has long been known as a regional health care hub. But a local physician says the impending influx of newly insured people might not keep the area from having to endure a shortage of physicians.

"There's always been a concern," said Dr. David Kowalski. "But Effingham has been very blessed over the years."

Kowalski, who practices out of Marshall Clinic in Effingham, said the quality of area health care has been fueled by the triad of a strong hospital, patients who can pay, and a wide variety of physicians, some of whom have been in the area for decades.

"That triangle has served this area very well," Kowalski said.

Nationwide, the shortage of doctors is expected to increase from 40,000 to 65,000 in the next 10 years. The increased shortage is attributed to the influx of people receiving health insurance as a result of the Affordable Care Act.

"It's a huge concern," said Kowalski, who is also president of the St. Anthony's Memorial Hospital Medical Executive Committee. "With 32 million people (nationwide) becoming eligible for insurance, the situation will get even worse."

While community leaders have long tried to recruit prospective physicians with a vision of Effingham as a small, family-friendly community, Kowalski said the reality is a bit different.

"It's not easy to recruit to rural areas across the board," he said. "Most doctors seem to prefer living in urban areas. I am concerned we will be not be able to maintain the supply of excellent physicians in Effingham that we currently have."

Kowalski said one problem is that the 1997 Balanced Budget Act froze the number of medical residencies funded through the Medicare program.

"Since 1997, we have 50 million more people in the United States, but we have not increased the number of residency opportunities," he said.

Kowalski said both the American Medical Association and Illinois State Medical Society are lobbying for an amendment to the act that would fund more residency opportunities. Meanwhile, he said an increase in the level of mid-level medical professionals is working to cover an ever greater shortage of full-fledged doctors.

"We're seeing more nurse practitioners and physician's assistants, who do a very good job with primary care," he said.

But Kowalski said there are times when the patient would most benefit from the advanced knowledge of a physician. He compared the tiers of primary care to working on a car.

"When I have to change my oil or rotate my tires, I take my car to my local mechanic," the doctor said. "But when there's something seriously wrong, I take it to the dealer.

"Doctors are kind of like the dealer."

Even though mid-level medical professionals are working to fill in the gaps, Kowalski said America is facing a shortage of them also.

However, changes in education could help.

Nurse practitioner Dot Behrns of Family Care Associates in Effingham said the advent of distance education is helping nurses upgrade their training to become nurse practitioners.

"We're definitely seeing more nurse practitioner students coming through," Behrns said. "Distance learning capabilities are allowing more nurses to become nurse practitioners."

Behrns said her clinic — with six doctors and five nurse practitioners — should be able to handle any influx of new patients. But she questioned whether rural counties in deep southern Illinois are in the same boat.

"We're very fortunate in Effingham in that we have a lot of primary care physicians," she said. "Southern Illinois is probably not as fortunate, because people in that area are already having to travel quite a bit for health care."

Kowalski said yet another factor leading to a physician shortage is the increasing amount of time that doctors have to spend away from their patients, including paperwork and regulatory matters.

"When I first moved here in 1997, I spent 20 percent of my time on non-patient care issues," he said. "Now it's closer to 50 percent."

Other area counties are expected to have an influx of new patients when the new insurance regulations kick in. In fact, the AP reports that Clay, Fayette and Shelby counties are among a number of central and southern Illinois counties facing a "severe" shortfall of primary care physicians. However, medical officials in some of those areas claim otherwise.

An executive at Clay County Hospital in charge of the hospital's medical clinic said her clinic is fully staffed.

Teresa Warfel, the hospital's director of rehabilitation and public services, said her clinic boasts five physicians and five nurse practitioners at locations in Flora and Louisville. Moreover, she said, the clinic is always recruiting new help in case one of those professionals decides to move on.

"You are always recruiting because of the time it takes to bring somebody on-board," Warfel said. "The on-board process is time-consuming.

"Once you are short-handed, it takes a long time to get the open position filled," she said. "You can flip from being fully staffed to under staffed in a heartbeat."

Warfel said one thing Clay County Hospital has tried to do is make the work-life balance more palatable for doctors.

"Doctors today don't want to be out working 24-7, so we instituted a program in which our primary care doctors are on call for one week at a time. Before, they were on-call all the time. Now it's seven weeks a year."

Paula Brodie, spokeswoman for the Southern Illinois Health Care Foundation, which operates clinics in Effingham, Vandalia and Greenup, said her group's focus is on educating the general public about various provisions of the Affordable Care Act,

"We want to make sure they can access the (insurance) marketplace, as well as access the best plan for their families," Brodie said.

While Brodie admitted the Affordable Care Act has created a situation where there are "so many unknowns right now," she said her group is confident that it can maintain an optimal level of providers, whether they be physicians or mid-level professionals.

"We are confident we will not experience a shortage of providers," she said.

Bill Grimes can be reached at 217-347-7151, ext. 132, or bill.grimes@effinghamdailynews.com.