It’s no secret: New Jersey is suffering from a shortage of primary-care physicians. The reasons are easy to find; coming up with the solutions is much harder—but a number of programs are giving it a shot.
Look for a plastic surgeon in the Garden State and you’ll have no problem. But if your family needs a doctor for basic health issues, you may be in for a shock—especially in certain urban or rural areas.
New Jersey does a good job of scaring away newly minted physicians. The cost of practicing medicine here is steep, and medical-malpractice rates are among the highest in the nation. Add the astronomical cost of medical school (and the loan payments that follow), and you start to understand the problem. What’s more, doctors everywhere complain about the high cost of the technology and record-keeping required to keep their offices running—and what they see as insufficient rates of insurance reimbursement.
You may have heard of the Affordable Care Act, which is currently being phased in. The ACA mandates that everyone will have health insurance. It’s a great idea, but who exactly is going to provide health care for these newly covered patients, especially in communities that are already underserved?
“The estimates that I’ve read say that by the year 2020, there will be between 2,800 and 3,000 fewer doctors than are needed in New Jersey,” says Marsha Atkind, executive director of the Healthcare Foundation of New Jersey. “That is a 12 percent gap between supply and demand…and because of the Affordable Care Act and the retirement of older doctors, this gap is going to widen.”
Adding to the problem is the large number of doctors who don’t accept Medicaid because the reimbursement rates are so low. State Assemblyman Herb Conaway (D-Burlington), chair of the Health and Senior Services Committee and a medical doctor, has experienced the problem firsthand. “Having my own office, I understand that you have to pay for staff, equipment and other expenses,” he says. “I would get, say, $45 from the insurance company for a patient visit, but only $9 from Medicaid.”
However, Conaway notes that reimbursement rates “will come up to Medicare rates” under the ACA reforms. “That is one thing that will help,” he says.
Local initiatives are under way to make primary care more accessible in underserved areas such as Newark. The Healthcare Foundation of New Jersey, for example, is funding a pilot project at the New Jersey Nursing School and UMDNJ to train community health workers to act as liaisons between their neighbors and the medical community.
“These individuals are taught how to take blood pressure readings and sugar levels,” says Atkind. “They help their neighbors understand how to take their medications properly and how to follow their doctors’ instructions…. It is empowering for the community, so that people don’t have to go to the ER unless they have a real crisis.”
Another creative solution is to expand the role of nurse practitioners, particularly in family medicine. According to Pat Barnett, chief executive officer of the New Jersey State Nurses Association, nurse practitioners are taking some of the burden off primary-care physicians by managing a number of patients with uncomplicated issues. “You don’t need to see an internist who specializes in diabetes if you are stable,” says Barnett. “Nurses are able to understand patient management, as they do it all the time and they communicate very well.”
There is no silver bullet to fix the shortage of primary-care physicians in New Jersey. And, although some novel approaches are being tried, not just those mentioned here, it would be wishful thinking to believe that they provide more than a partial solution. The prognosis for patients is bad, especially for those in our underserved communities.
Steve Adubato, PhD., is an Emmy Award–winning anchor for Thirteen/WNET (PBS) and NJTV (PBS) who regularly appears on the Today show, Fox 5 in New York and WOR NewsTalk Radio 710. His newest book, You Are the Brand, examines the brand strategies of more than 30 individuals and companies. For more information log on to stand-deliver.com. Find Steve on Facebook at Facebook.com/SteveAdubatoPHD.