Published: February 12, 2014
El Paso County has one of Colorado's worst shortages of primary care physicians - a problem that's particularly acute among Medicaid patients, according to a study released Tuesday.
Another 120 primary care physicians - or a 54 percent increase - are needed in El Paso County to reach a desirable ratio of 1,900 patients to every full-time physician, the Colorado Health Institute found.
The county's shortfall represented an outlier in Colorado because populous counties appear well-staffed with physicians, while rural communities - particularly in the mountains and across the eastern plains - suffer deep shortages.
Overall, Colorado's patient-to-physician ratio was a healthy 1,873 people for each full-time primary care physician.
Denver, Boulder, Broomfield, Mesa, Pueblo and Larimer counties boasted the best ratios in the study, which compared the populations of 21 geographic regions with the number of full-time equivalent physicians in each area.
The area encompassing Teller, Clear Creek and Gilpin counties needs an additional 13 physicians, a 79 percent increase.
"It's a distribution issue, in terms of where they decide to practice," said Amy Downs, the study's editor, and the institute's senior director for policy and analysis.
Observers say the problem manifests itself in increased emergency room visits, lengthy wait times for physician appointments and in people going without the care they need, especially for chronic illnesses.
El Paso County has a high number of nurse practitioners and physician assistants, which likely helps mitigate the shortage, Downs said.
Still, the findings came as little surprise to Mike Ware, with the El Paso County Medical Society.
"It shocked me, frankly, to find out how difficult it has been to recruit physicians to the area," Ware said.
Myriad factors play into doctors' hesitancy for moving here, he said, including a perception that the region isn't a hub for medical care, as well as transportation issues, such as the lack of direct flights out of the Colorado Springs Airport.
One of the biggest factors may be the region's lack of a residency program, he said. In announcing its findings, the institute referenced a study by the University of Washington that found medical students prefer to practice near their hometown or near their school.
Memorial Hospital plans to provide clinical training to third- and fourth-year medical students, but the first of those won't arrive in Colorado Springs until 2016.
"I don't think it will solve the entire problem, but I think it will help," Ware said.
The report only looked at primary care physicians, described as family, internal, general or pediatric doctors. It did not include specialists, nor did it examine the lack of psychiatrists in the Pikes Peak region.
It also only looked at physician-patient ratios before implementation of the Affordable Care Act, much of which became effective Jan. 1.
In El Paso County, the physician shortage was worst among Medicaid patients - a problem that could worsen as Medicaid expands under the health law, study authors said.
The county needed another 22 doctors in 2013 who accept Medicaid - a 122 percent increase. Study authors say that the generally accepted ratio of Medicaid doctors to patients is 1,500 to one, because those patients typically require more care for more complex medical issues.
Beginning this year, almost anyone with an income up to 138 percent of the federal poverty line can receive Medicaid - meaning an additional 440,000 enrollees across Colorado by 2016, the study said.
Much of that burden in the Pikes Peak region could fall on Peak Vista Community Health Centers, which is expanding its services in light of Medicaid's expansion. About half of the 66,000 patients on Peak Vista's rolls in 2012 used Medicaid.
The nonprofit is operating around the suggested 1,500-to-1 patient to physician ratio, said Dr. Michael Welch, Peak Vista's vice president of medical and dental services.
While Peak Vista receives special funding via its status as a federally qualified health center, other physician practices might find it more difficult to treat those patients, he said.
"The reimbursement rates that the state pays for Medicaid are such that physicians can't see large numbers from a percentage standpoint," Welch said. "Because they would go broke if they did."
EDITOR'S NOTE: This story has been corrected to accurately reflect the type of medical training program coming to El Paso County. Third- and fourth-year medical students will get clinical training at Memorial Hospital and other locations in the county beginning in 2016, said Mark Couch, spokesman for University of Colorado School of Medicine. Those students wouldn't apply for residency programs until they graduate from medical school, he said.