A persistent dearth of doctors in most of New York could slow the implementation of health care reform unless something is done to alleviate the shortage, a new analysis has concluded.
The biggest inadequacy is in the number of primary care physicians, who now represent only 18 percent of all doctors statewide, according to a report titled "Doctor Shortage: Condition Critical" by the Healthcare Association of New York State, which writes policy on a variety of health care issues.
A paucity of physicians is evident in every part of New York, the investigation found, except New York City.
More than 1,200 doctors are needed statewide -- about one-third of them primary care physicians -- to meet the demands of the Affordable Care Act, the association found. Health care reform places an emphasis on primary care.
Dr. Steven Walerstein, medical director of Nassau University Medical Center in East Meadow, said news of the shortage comes as no surprise to him. "There's a national, regional and local shortage of primary care physicians," Walerstein said.
For years, medical school graduates have shown a stronger interest in training for medical specialties, where the remuneration is higher. Medical students have shunned family practice, general pediatrics, obstetrics and gynecology and other areas of primary care, experts say.
Medical school graduates have also complained about long hours and the hassles of primary care, Walerstein said.
Daniel Sisto, president of the health care association, said with thousands of New Yorkers destined to gain insurance coverage with the ongoing rollout of health care reform, the state "must have a comprehensive strategy to address this shortage and ensure all New Yorkers have access to care."
The New York State Department of Health has responded with the establishment of an Office of Primary Care. The health department also oversees Doctors Across New York, an initiative to help train and place physicians in underserved communities.
Despite those efforts, the report found 32 percent of the state's health care facilities surveyed over the past year had to reduce or eliminate medical services because of the physician shortage.
Worse, 75 percent of hospitals, most in upstate New York, were found to have no coverage in their emergency departments for certain medical specialties, particularly neurosurgeons, which suggests the doctor shortfall affects many specialties as well.
In instances when patients required a specialist, they often had to be transferred to another hospital. This is the second year running that the association has found a shortage of emergency room specialists.
Sherry Chorost, who directs workforce issues for the health care association, said many of the problems involving the shortage of primary care physicians can be ameliorated with the establishment of the so-called patient-centered medical home.
The model was first proposed in the 1960s.
Walerstein noted that NUMC has already established such a model of care on Long Island.
"The patient-centered medical home is a model of patient care that involves a health-care team," he said. "In this model, non-physician providers, such as nurses, nurse practitioners, physician's assistants and dietitians augment the care of the physician."
Under a team approach, doctors have more time for patients, especially those with complex problems, he said.