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Newly insured will be met with shortage of care providers

| Monday, Sept. 30, 2013, 12:08 a.m.
Evan R. Sanders | Tribune-Review
Gabrielle Sakellarides, D.O., a resident at Cornerstone Care Teaching Health Center in Mount Morris, listens to the breathing patterns of a patient during clinic hours on Wednesday, Sept. 25, 2013. Cornerstone Care Teaching Health Center has recently entered a partnership with Mon General Hospital in Morgantown to create a family medicine residency program.
Andrew Russell | Tribune-Review
Maliyah Howell, 21 months, of Swissvale gets an exam from Dr. Jeannette E. South-Paul, University of Pittsburgh Chair of the school's Department of Family Medicine, and practicing physician as Howell's mother, Carrie Little, 28, of Swissvale holds her at UPMC Matilda Theiss Health Center in Oakland, Thursday, Sept. 26, 2013. Dr. South-Paul delivered Howell and has since been her PCP.

As Pennsylvanians begin to shop on Tuesday for government-subsidized insurance, health care providers question whether they can accommodate the anticipated influx of patients.

“We're going to be inundated with patients,” said Dr. Jeannette South-Paul, a family doctor at UPMC's Matilda Theiss Health Center in Oakland and chair of the department of family medicine at the University of Pittsburgh School of Medicine. “There really aren't enough of us (doctors).”

More than 200,000 uninsured people live in Western Pennsylvania, an estimated three-quarters of them adults in Allegheny County alone, industry experts say.

The newly insured will head to doctors' offices and hospitals at a time when Pennsylvania's physician workforce of about 32,000 cannot meet existing demand. Most counties, especially those in rural areas, report shortages of doctors, according to the Pennsylvania Medical Society.

“We won't have the providers to meet the demands,” said Dr. William Minor, director of a Morgantown, W.Va.-based family residency program that is training four physician residents at Cornerstone Care Mt. Morris Health Center in Greene County. “If a person trains in a rural setting, they're more likely to stay here.”

Predicting how quickly new patients might seek care is impossible, said Dr. Richard Schott, a suburban Philadelphia cardiologist and president of the state medical society.

The sign-up period that begins Tuesday for health insurance in online marketplaces runs for six months, though government officials hope many people will enroll by Dec. 15. Coverage begins in 2014.

Last week, Oregon, Colorado and the District of Columbia said their online exchanges — among 51 set up — experienced information technology problems that could affect some functions and lead to a slow start.

“It's very unlikely that 30 million people are going to instantly appear on the doorsteps of physicians across the country as of Jan. 1,” Schott said. “Historically, people in this country and in this state have had access to care. It's an exaggeration to say these people haven't had care or haven't had access to care.”

The potential onslaught of patients prompted health care workers such as nurse practitioners to seek more independence. State Sen. Pat Vance, R-York, this year introduced a bill that would let nurse practitioners practice independently of doctors in some clinical settings.

“We think that's not safe,” Schott said. “There's a vast difference in training. There's a concern about the liability and delay to getting patients to appropriate care.”

Most physicians instead support a team approach to delivering care, much in the way it's done at Matilda Theiss Health Center in Oakland. Health care professionals there treat patients with a mix of insurance coverage. A third of the patients are uninsured.

Under a model known as the patient-centered medical home, a primary care doctor manages a patient's care but patients can consult pharmacists, nurses, social workers and other medical specialists under the doctor's direction.

“Physicians must be in the mix,” South-Paul said. She pointed to research showing that patients in areas with a higher number of primary care doctors tend to have better outcomes, and fewer die.

The region's hospitals are trying to recruit primary care doctors. At UPMC, the largest health care provider with 20 hospitals and 400 outpatient sites, officials recently hired 20 primary care doctors and expect to hire about 30 next year from Pitt's School of Medicine.

“We are adding primary care doctors as quickly as we can,” said Dr. Steven Shapiro, UPMC's chief medical and scientific officer.

Very sick patients come to hospitals with or without insurance, Shapiro said.

“I'm not sure we're expecting too much of a difference in admissions,” he said. “We've got many extra hospital beds in this town.”

Luis Fábregas is a Trib Total Media staff writer. Reach him at 412-320-7998 or lfabregas@tribweb.com.

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