June 26, 2011
Colorado doesn’t have enough primary care physicians. And the shortage is expected to worsen in coming years.
“In Colorado, we need 194 primary care docs in underserved communities — now,” said Steve Holloway, director of the Office of Primary Care of the Colorado Department of Health and Environment.
“In the next three years, that number will more than double.”
Medical professionals and administrators statewide are grappling with a big crunch – because there aren’t enough graduating primary care physicians to replace the family doctors about to retire.
The average age of a primary care physician in Colorado is 55. Many of them will be hanging up their stethoscopes in as little as 10 years.
The shortage is expected to worsen in 2014 when the federal health care law is due to add 32 million people to health insurance. Treating their postponed health problems will require more time from primary care doctors.
If they don’t have one now, Coloradans might want to find their own family doctor soon, Holloway suggested.
The state has 3,271 licensed primary care physicians. Most of them work in affluent areas of Douglas, Arapahoe and El Paso counties.
Poorer — often urban — areas have the most critical need for primary care, including inner city Denver and Adams County.
Enormous swaths of rural Colorado also are facing severe shortages, including the San Luis Valley and nonresort areas of the mountains. There is no primary care physician in Jackson County in north-central Colorado.
In the southeastern towns of Rocky Ford and Ordway, patients are largely monitored by nurse practitioners, who handle everything from prescribing psychiatric medicine to setting bones.
On Thursdays, Dr. Ozzie Grenardo makes a 300-mile loop from his family practice in Parker, near Denver, to the two southeastern towns to see patients.
“I wish I had frequent flier miles for my car,” Grenardo joked during one weekly road trip, as he was driving from clinic to clinic. Still, says the Colorado Springs native, “I don’t mind my long Thursdays. It’s an escape from the routine.”
Grenardo, 38, says he wanted to go into family medicine since before he started medical school. “I know a little bit about everything, and have amazing relationships with my patients, whereas a specialist knows a lot about a specific field and may only see a patient once for a specific procedure.”
But not all young doctors-in training have the same priorities as Grenardo. The number of American medical students who go into primary care has dropped by half since 1997.
Holloway explains that young medical students often are “idealistic” when they start medical school.
“At first, as many as 40 percent of them express a desire to go into family medicine,” Holloway said. “But by the time they graduate, that number plummets to only 2 percent.
“They change their minds when they find out how much loan debt they’ve rung up.”
With as much as $300,000 in loans, a half million dollar a year surgeon’s salary can be can be far more appealing than the $130,000 to $140,000 earned by a family doctor.
“It’s a mortgage worth of debt,” say Longmont primary care physician Dr. Mike Laitos. He remembers the star status of choosing a specialty over family medicine.
“When I was in medical school in the late ’70s, the attitude was, if you’re a really good doctor, you specialize.”
Colorado is in the middle compared with other states in terms of the urgent call for more primary care physicians, with Detroit and the Mississippi Delta having the most critical need.
In Colorado, a program operated by the state Department of Public Health and Environment offers incentives to recruit medical students for family practice.
The “Colorado Health Service Corps” pays as much as $150,000 of a graduating medical student’s educational loans in exchange for a promise: The graduate must practice full time for three years in a federally qualified area.
Now a year and a half in existence, the program has matched 80 to 100 young doctors with underserved populations. The program has sent young primary care physicians to Pagosa Springs in southwestern Colorado, Eads in the northeast part of the state, to the Westside Family Health Center in Denver, and places in between.
“When we go over the applications, we are looking for professionals who maybe grew up in a small town and want to stay put,” Holloway said. “We pay for three years, but we want a lifetime.”
Enter other medical professionals, including nurse practitioners, who are highly trained in most aspects of providing family health care but lack a medical degree.
In Colorado’s Rocky Ford, for example, the city hosts Grenardo as a part-time doctor, but Doug Miller has been a nurse practitioner there for 13 years. He is known around town as “Dr. Doug.” It’s common for him to treat patients ranging from a 3-day old to a man of 96 who is still ranching.
“It’s going to be interesting to see how the medical field will change in this new world of health care,” Grenardo said. “The nurse practitioners truly can do everything I do. We teach each other.”
Grenardo suggests that health care professionals utilize telephone or Skype computer conferences as good substitute when an M.D. can’t physically be where a patient is.
Dr. Laitos, the Longmont family doctor, understands the predicament facing underserved areas such as Rocky Ford.
“The depth and breadth of knowledge a doctor receives is valuable, but if that doctor is not willing to move to your town, you will need to see a (nurse practitioner),” he said.