Dr. Louis Papa's practice in Brighton handles 3000 patients and like many primary care offices in Rochester it's booked solid.
“It fills up by 10 ‘clock, all of the appointment slots are filled up,” says Papa, who is part of the Olson Medical Group which serves nearly 30,000 patients in the Rochester region, “for a physical, apparently, I'm booking out in May.“
Dr. Papa’s practice is also not accepting new patients; he hasn’t taken a new patient in years. However, the problem is not just limited to Dr. Papa. There is a growing trend of decreasing physician specialties in the Rochester region.
The latest numbers from the Healthcare Association of New York State (May 2007) show Rochester is lacking: five endocrinologists, three intensivists, two urologists, five general surgeons and 104 primary care doctors.
“There comes a point when you have to decide your access is big enough that you can provide the care in a timely manner with reasonable access for your patients,” says Dr. Papa.
The way primary care doctors treat patients has changed dramatically over the last few decades. Doctors no longer treat patients based on an “acute care model” where patients are treated on an as needed basis i.e. a patient becomes ill, he or she goes to the doctor. Today, primary care doctors spend much of their time treating chronic conditions such as diabetes, hypertension and heart disease.
“And there's more and more pressure from above to better manage chronic conditions, so there's better outcomes, make sure they live longer, they live better,” says Dr. Papa who says the chronic care appointments tend to fill the majority of a daily schedule, often pushing more common appointments such as physical exams back weeks, even months.
Retirement is a pending problem which may make the shortage worse in the next five years. Among primary care doctors and general surgeons, many are age 55 or older and nearing retirement. Another issue exacerbating the physician shortage in Rochester is low reimbursement from insurance companies. While the general reimbursement level is low for many specialties, it is particularly low for primary care doctors.
“When you are a primary care doctor, there's not a lot of procedures you do...so you don't operate, you don't do fancy procedures where there's higher reimbursement,” says Dr. Papa.
The reimbursement issue is also making recruitment of new doctors to the Rochester region particularly difficult in primary care.
“We’re losing them to places outside of New York State, we're losing them to places with better reimbursement,” says Papa.