Page 24 - Delaware Medical Journal - May/June 2018
P. 24
Physician Shortage:
A Primary Care Crisis in Delaware
Deborah T. Zarek, MD, FACP and James M. Gill, MD, MPH
Delaware currently is in a primary care crisis. There are shortages of primary care physicians across the
country. Delaware is particularly affected, having fewer primary care physicians per capita than any surrounding state. The problem is getting worse, with primary care physicians leaving the state, retiring early or shifting to concierge medicine. The result is poor access to primary care for Delawareans, leading to poor quality of care and higher costs.
How did we get to this place? There are
primary care physician, but the main factor comes down to the surprising Delaware. Commercial payers across the United States typically pay 120 to 130 percent of Medicare rates in primary care. Delaware is a strange anomaly, with commercial payers reimbursing private primary care physicians 15 to
30 percent below Medicare rates. Our that this discount given to commercial payers led to a loss of $100,000 in income for our practice in the past year. Such lost revenue limits the funds we
can put into our practices to ensure proactive care, not to mention paying
the rent and electricity. In essence, sustaining a traditional primary care practice in Delaware becomes more and more challenging. It is no wonder that physicians would consider practicing in a surrounding state instead.
Research has shown that the more a country or region spends on primary care, the better the health outcomes and the lower the price. Indeed, the rest of the developed world has embraced this and diverts a higher percentage of its health care budget to primary care.1 In the United States, we have taken small steps in this direction with the start
of Patient-Centered Medical Homes (PCMH) and Medicare beginning to pay for Chronic Care Management (CCM). can be a burdensome transformation for many practices, and these reforms are far 2
Delaware has the third-highest health care costs per capita compared to other states, but ranks in the bottom half for
quality and outcomes.3 While Delaware has higher rates of chronic disease and an older population than most parts of the country, the state does poorly even after controlling for these differences. force is our lack of accessible primary primary care providers in the state to meet the demand. Despite this, Delaware is experiencing a rapid decline in its primary care workforce.
So, where are all our primary care doctors going? Many primary care physicians years to retire early or become hospitalists. Some have moved into Maryland, or other states where payment is better. Medical students are not going into primary care, as they know it is hard work with poor pay. This year, not a single Internal Medicine resident from Christiana Care is going
into primary care. The Family Medicine Residency Program at Christiana Care has one graduating resident going into full- time primary care in Delaware, with two becoming residency faculty with part-time practices. Without primary care doctors
as the gatekeepers, the entire health care
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Del Med J | May/June 2018 | Vol. 90 | No. 5
