More than 1 million uninsured Michigan residents could benefit from national health care reform, but any surge in new patients could further strain a doctor population bracing for a shortage in crucial specialties.
Michigan doctors already are struggling to meet the demands of an aging baby boomer population and to attract more medical school graduates into the fields of family medicine and general practice. The increasing complexity of medicine also has spurred a greater need for doctors, a trend that's only going to continue as medical technology advances.
The number of medical school graduates entering into primary care fields such as general pediatrics and family medicine is tapering off because many new doctors burdened with hefty student loan debt are gravitating to the more lucrative subspecialties. And close to half of the state's active physician work force will reach retirement age within the next 10 to 15 years.
While the state has improved the doctor-to-patient ratio the last few decades, the Michigan State Medical Society projects a 6,000-doctor shortage by 2020, with the deficit most pronounced in primary care, as well as in urban and rural areas.
"You figure there are 1.1 million uninsured. If we're really to cover the majority, that's nearly a million people flooding into the system that is, in many places, at capacity or over capacity at this point," said Dr. Margaret Meyers, medical director of Mercy Primary Care Center, a free clinic on Detroit's east side.
The lack of doctors could mean longer patient wait times and erode the quality of care because physicians will have to shorten visits to handle overflow, medical experts say. Shortages in primary care are especially problematic because they increase the number of patients landing in hospitals for illnesses that could have been prevented with routine visits.
At the same time, health policy experts are touting increased access to primary care as a vital component to overhauling the nation's ailing health system and stemming rising medical costs.
Moving more patients into primary care will curtail emergency room visits for routine care and stem the rise in preventable hospitalizations, health experts say. The impact will be lower overall costs, since hospital care is among the most expensive in the system -- but it could further burden primary care doctors as their ranks are shrinking.
"If we advance primary care, which we're almost certainly going to do in any health reform model, then we've got a compounded issue," said Steve Creamer, manager of the professional practice section of the Michigan Bureau of Health Professions.
Shortage felt more in Mich.
Primary care doctors account for about 34 percent of the state's 29,300 active physicians, a percentage that hadn't budged since 2005, according to a 2008 state survey.
And Creamer said many primary care physicians, as well as support staff in this field, are leaving the specialty at a quickening pace, a worrisome trend considering the emphasis on increasing access to preventative medicine.
"It concerns me in terms of where is this care going to come from," Creamer added.
The shortage is likely to be felt more in Michigan than other states.
The faltering economy, coupled with many residents losing employer-backed private insurance and adding to the Medicaid roll, has prompted many medical school graduates and practicing physicians to flee Michigan.
The state doesn't keep solid figures reflecting this out-migration, but the problem has caught the attention of medical leaders who are considering launching a campaign to draw more doctors to the Great Lakes State.
"We have a lot of people who have trained in our state hearing this message that you can't build a practice here because the insured population is going down," said Anne Rosewarne, president of the Michigan Health Council, a group supporting health care worker recruitment and retention.
Many graduates, she said, leave school with debts above $250,000, making them reluctant to specialize in primary care -- where, by some estimates, physicians make about 30 percent less than the average doctor salary -- and prompting them to seek places better off economically.
"When you're looking at that kind of debt, you want to go somewhere where you can set up a profitable practice and have a life," she said.
The state continues to suffer from an uneven distribution of doctors, with more physicians opting for the well-heeled suburbs over urban or rural areas, said Dr. Steven Gay, assistant dean for admissions at University of Michigan's Medical School.
Relocation hurts Detroit
Urban areas, such as Detroit, may experience the shortage more acutely than others if medical coverage is expanded.
The city has lost 67 percent of its primary care physicians since the mid-1990s, with many relocating to the suburbs where there are more privately insured patients, said Dr. Herbert Smitherman, an assistant dean at Wayne State University's medical school.
He said about 22 percent of Detroit's population -- about 200,000 -- lack health insurance and another 35 percent or 330,000 are on Medicaid, a state and federally funded program that pays doctors much less than private insurers.