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"Medicine has changed," says Southfield's Dr. Sylvia Hollowell, with patient Mark Croft of Detroit.Family docs become a dying breed
Michigan shortage looms; costs, specialty fields cited
What's up, doc?
Family doctors, who meet the broadest and most basic health care needs, are being driven from the field by age, rising business costs and increasing job pressures. Squeezed for time and money, they are cutting back hours and staff or leaving the profession completely. How long has your family been with a stable doctor?
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The Rockwellian image of a kindly doctor watching over generations of family members is slowly fading into little more than a nostalgic memory in Michigan.
Family doctors, who meet the broadest and most basic health care needs, are being driven from the field by age, rising business costs and increasing job pressures. Squeezed for time and money, they are cutting back hours and staff or leaving the profession completely.
"Even some of my younger colleagues are just hanging up their hats and going into different fields altogether," said Dr. Sylvia Hollowell, a family practice physician in Howell.
In five years, Hollowell has seen her rates for malpractice insurance grow from 10 percent of her business costs to 15 percent, while Medicare reimbursements that cover more than half of her patients have fallen. "Medicine has changed," she said. "It's just not like it was 10 years ago."
About 15 percent of Michigan's approximately 30,000 doctors are family practitioners, according to a recent report from the Michigan State Medical Society.
They represent the largest group among primary care doctors in Michigan, which also includes internists, pediatricians and obstetricians/gynecologists.
Looming shortage
According to the report, Michigan faces an overall shortage of 6,000 doctors by 2020, including a slight shortfall of primary care doctors, especially among family practitioners and OB/GYNs.
The looming shortage of family physicians could drive up health care costs as patients wait longer to see a doctor, have less access to preventive care and rely more on emergency rooms and urgent care centers for routine visits.
Primary care, from annual pap smears to cholesterol-lowering drug treatments, is the key defense against costly and chronic disease. An emergency room visit for a heart attack, for example, runs about $40,000; a prescription blood thinner that could prevent that attack costs hundreds a year.
That's why preventive and maintenance care is vital to heath, doctors say.
"In every country that has a strong primary care network, the population tends to be healthy and taken care of as opposed to running from one specialist to another," said Dr. Steven Grant, a Farmington Hills physician. "If the trend persists, we will see this happening in the next several years."
More than a quarter of Michigan's 12,700 primary care physicians are at retirement age, according to a recent report from the Michigan State Medical Society. At the same time, today's medical students are being lured to specialty fields that promise better pay, more manageable hours and the chance to work with flashy new technologies and treatments.
Some patients, frustrated by long waits to see traditional primary care physicians, are turning to specialists and services tailored for convenience, such as mini-clinics in retail stores and telemedicine.
Less-accessible primary care will lead more patients to run up expensive bills in emergency rooms and urgent care clinics for treatments they could have received in a routine visit. And they won't get the care they need to prevent more serious ailments.
Waiting for care
Southfield's Tara Scott found out how difficult it can be to find a primary care doctor. Scott's daughter, who is 14 months old, had frequent bouts with ear infections and common viruses during her first year. At least three times, Scott said, she tried to make an appointment with her pediatrician only to be told the doctor wasn't available for at least two weeks. Scott herself once couldn't get in to see her regular doctor for a sinus infection and had to find another physician she'd never met to get a prescription for an antibiotic.
"I don't think you can go to a doctor's office without waiting," Scott said. "It's stressful when you're not feeling well to be told you have to wait a week or two to get help."
Most signs point to the situation getting worse. A slowdown in the number of students entering medical school as well as an aging population are responsible for the shift.
Family medicine is faring worse. Nationwide, the number of medical residents preparing to go into family practice dropped 9 percent from 1997-98 to 2002-03, while the number of residents going into internal medicine dropped 3 percent, according to a report from the Association of American Medical Colleges. The overall number of medical residents, however, increased from 98,143 to 98,258.
The story's the same in Michigan, where the state's four medical schools are seeing more of their students head toward medical specialties.
Michigan's medical schools are working to encourage students to consider family practice, trying everything from requiring a family practice rotation to scholarships.
More than half of the students at Michigan State University's College of Osteopathic Medicine go into family medicine and, bucking a state trend, about two-thirds stay in the state to practice. Statewide, about half of medical students leave after completing their education. To help address a family doctor shortage, the college this year upped its enrollment to 206 from 147.
Lure of specialty practice
But the trend away from family medicine is difficult to fight. Family doctors face an average medical school bill of $120,000. Malpractice rates are increasing fast, particularly in Detroit and Wayne County, and payments that doctors receive from Medicare and Medicaid have been stagnant or dropping. To keep incomes steady, doctors must see more patients and, in some cases, turn away Medicare patients in favor of those with private insurance. That means more paperwork and less time to spend with each patient.
Doctors also must keep up with drug treatments and new procedures. They need to buy and become trained on the latest technology. Primary care physicians, who cater to a wide range of patients, must keep up on several areas of medicine, not just a single specialty.
"Most of my friends who are primary care doctors, they are trying to dissuade people from going into primary care," said Dr. Alan Mindlind, president of the Michigan State Medical Society.
"They are not optimistic about the role of primary care physicians going into the future."
Adding to the downsides of going into family medicine is the growing allure of other fields. Today's surgeons have robots, needle-size cameras and laser technology to perform procedures unheard of even a decade ago. Pay also is a major issue. A family practice physician on average makes $143,000 annually, compared to more than $346,000 for an orthopedic surgeon or $438,000 for a neurologist.
"Everybody wants the high-glitz things," said William Strampel, dean of MSU's osteopathic medical school. "But the reality is that 90 percent of care is done before that guy even hits the operating table."
Still, new ways to deliver health care could ease the situation.
Advances in technology that let doctors treat patients over the Internet and phone allow doctors to take on more patients. As the growing field of telemedicine changes, the need for doctors will fall, said Grant, who's also president and CEO of United Physicians, an organization of 1,500 physicians associated with Beaumont Hospital.
"We have the Web, remote sensors, all sorts of things," he said. "These could all be applied to the care of people right now."
You can reach Sharon Terlep at (313) 223-4686 or sterlep@detnews.com.
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