The Free Press, Mankato, MN

July 5, 2013

Mayo, Mankato Clinic prepared for primary care doc shortage

Affordable Care Act will put strain on primary care

By Robb Murray

---- — A medical issue that was a mere festering sore for years could turn into a major wound once the Affordable Care Act fully kicks in.

The Affordable Care Act promises to insure millions of people who previously didn't have insurance. This will put a strain on hospitals and clinics, and one area of medicine in particular: primary care.

A shortage of primary care physicians already exists in some parts of the country, and it's expected to get worse. What it means is that, while people may be thrilled to finally have health insurance, they may be forced to wait a long time before they can actually see their doctor.

Nearly one in five Americans already lives in a region designated as having a shortage of primary care physicians, and the number of doctors entering the field isn't expected keep pace with demand.

The Mankato area, meanwhile, isn't quite as bad off as other parts of the country. Both Mayo Clinic Health System in Mankato and the Mankato Clinic have taken measures to mitigate the impact of the shortage as much as possible.

"(The shortage) is not news to us," said Dr. Greg Kutcher, CEO of Mayo Clinic Health System in Mankato. "It's been an issue for many, many years, probably decades. We've been proactively working on this for a long time. It doesn't mean we're not affected by it but I think we're in a better shape than a lot of places."

One thing Mayo has done, Kutcher said, is establish a relationship with the University of Minnesota's medical school. Between 1997 and 2013, 71 family medicine residency graduates have worked with MCHS. Of those, 46 are practicing in Minnesota, and 21 have stayed within MCHS.

Kutcher said it's a unique set up in Minnesota. The partnership began in the Waseca hospital but eventually moved to Mankato.

Dr. Julie Gerndt, psychiatrist and chief medical officer for the Mankato Clinic, said they've focused their efforts on combating the shortage on recruitment.

"We continue to aggressively recruit primary care physicians to our community, and have been successful," Gerndt said. "The Greater Mankato Area is attractive to physicians; the economy, diversity, educational opportunities, geography and recreational opportunities draw interest. And we as an organization are appealing to new physicians. Most importantly, we serve a community of patients that is highly engaged and interested in its own health."

Both the Mankato Clinic and MCHS say they also tried to transition to team-based health care. The days when one doctor was the best way to go are becoming a thing of the past, they say, partly because of the shortage and partly because, in many cases, a team can provide better care.

"We have created a team approach to care that allows all team members to work to the top of their credentials and abilities," Gerndt said.

The Mankato Clinic is touting what it calls the Patient-Centered Medical Home, which it says will provide "more efficient, reliable and effective care for our patients with complex and serious health conditions. It also provides for meaningful collaboration with our patients’ community resources and care providers, including nursing homes, group homes, social services, public health and home health care providers."

Over at MCHS, they're also moving away from a one-doctor-fits-all approach.

"It's not so much 'Who's my doctor?' but 'Who's my system?'" Kutcher said. "The trend is to have a team-based model."

For the past few years, MCHS has been piloting several team-based care models that involve using nurse practitioners and physician's assistants. Dr. Gerald Kowal said they're goal is to get patients comfortable with the idea of seeing a nurse or physician's assistant for things that don't necessarily require a doctor's attention. Doing this can cut down on wait times and free up doctors for cases that require their attention.

For example, a patient who needs to have hypertension medication checked and adjusted could just as easily see a physician's assistant. Also, they're exploring the possibility of electronic visits.

"It doesn't always have to be that face to face visit," Kowal said.

Added Kutcher, "Before people might call and say, 'I have a sore throat, can I see Dr. Kowal?' And we'd say, 'He's busy, can you see another doctor?' Well, now maybe we'll say “He's busy, but would you mind talking to a nurse? Maybe you won't even have to come in.” A lot of people are OK with that."

About a quarter million primary care doctors work in America now, and the Association of American Medical Colleges projects the shortage will reach almost 30,000 in two years and will grow to about 66,000 in little more than a decade.

The national shortfall can be attributed to a number of factors: The population has both aged and become more chronically ill, while doctors and clinicians have migrated to specialty fields such as dermatology or cardiology for higher pay and better hours.The shortage is especially acute in impoverished inner cities and rural areas, where it already takes many months, years in some cases, to hire doctors, health professionals say.

This report contains information from The Associated Press.