TONAWANDAS: County needs more doctors

By Daniel Pye/pyed@gnnewspaper.com

If you need a cardiologist, urologist or surgeon in Niagara County, you’re in luck. But if you have a cold you can’t kick and want to see a primary care physician, it could be difficult to locate one.

That’s because the county has seen a growing trend away from primary care and toward more specialized medical professions, said Tamara Owens, president of DeGraff Memorial Hospital.

“Many physicians don’t want to go into primary care,” Owens said. “They want to go into procedural-based things, whether it’s dermatology, anesthesia, surgery or radiology. With all of those things, the more testing you do, the more money you make.”

The hospital had Kurt Salmon Associates take a look at the county just over a year ago, and the firm found that the county needs at least 30 more doctors to appropriately meet the population’s demands. But even though the patients are here, hospitals are having a tough time luring primary care doctors to the area.

Part of the reason is the area’s climate, which some recent medical graduates looking to relocate see as unappealing when compared to warmer Southern states. Another component of the problem is the difficulty involved with starting a new practice. In years past, doctors were willing to be on-call every night to build patient volume, but many new doctors aren’t willing to adapt to that kind of lifestyle, Owens said.

“When we’re recruiting for positions, many say they want to work in an office space,” Owens said. “They want to work Monday through Friday, nine to five and don’t want to round at the hospital. Typically, that kind of nine to five position worked at the hospital and rounded on weekends, but it’s a different environment than it used to be.”

Olivia Smith-Blackwell, MD, started her practice in North Tonawanda six years ago and said her patient list has grown rapidly. Even so, starting a private practice is just as much about juggling the overhead as it is about good medicine, she said.

“I think it’s challenging no matter where you set up,” Smith-Blackwell said. “Probably what’s most challenging for a new physician is they have excellent medical training, but might not know how to set up a business of what the additional costs involved in setting up a business are.”

Entering a group practice is one way to mitigate those concerns, but those looking to strike out on their own have to build a practice like any other business. That means paying employees before paying themselves and isn’t something that many doctors are willing to do, Smith-Blackwell said.

Raised in New York City, Smith-Blackwell said she relocated to live in an area with a tight-knit community where she can still be close to nature with access to many of the amenities offered by city life. But many doctors don’t have similar inclinations and tend to go where the money is.

Arvind Wadhwa, MD, has been practicing in North Tonawanda since 1988 and said he can count on one hand the doctors he’s seen come into the area in that 20 year period. That means hospitals have to offer subsidies in order to compete, and DeGraff is no exception, Owens said.

“When we have areas such as this that have been demonstrated to be underserved from a physician population, we’re able to help recruit physicians to the area,” Owens said. “We can give them an income guarantee. That might be for two years you guarantee they’ll make 130,000 and if they only earned $75,000 then we would be the backstop for the remainder. That’s the only way we’re going to be competitive.”

In return for that assistance, the doctor signs on to stay in the area for two more years after the agreement expires. Owens said that long a time in the area will hopefully let the doctor develop ties to the area, but there are no guarantees. New York state isn’t a very friendly place for doctors where Medicare reimbursement is concerned, and within the state Western New York has some of the lowest rates, Wadhwa said.

“For a procedure for which I will be paid $50, someone would get $60 to $65 for in Albany,” Wadhwa said. “In New York City, that might jump to $80. If someone wants to stick around in this state, they’re looking at these places where they can get higher reimbursement.”

Physician fee schedules are procedurally based, so doctors only make money when running tests, doing procedures or giving injections. The one-on-one interaction and conversations that can lead to better health isn’t something for which the patient can be billed, leading doctors to gravitate toward specializations that involve more procedures and less patient interaction, Owens said.

For a patient with a primary care doctor, an acute illness can get them bumped to the top of the list. Wadhwa said he tries to see patients the day they call or the next day if they have an illness. But for new patients, it takes a couple of months to schedule a visit. That leaves people without a doctor lining up in emergency rooms or urgent care facilities, paying more and waiting much longer than they should, Wadhwa said.

“When they end up in those places for something like a sinus infection, their care is compromised,” Wadhwa said. “In an emergency room they might wait three or four hours before they’re seen. Even in an urgent care facility they’re looking at broken up care because they don’t have a regular doctor to follow up.”

Owens said DeGraff’s ER visits have gone up every year, with many of the patients who are admitted without a primary care doctor.

To increase their ability to handle the area’s patients, doctors are expanding their mid-level staffs. Wadhwa has added a nurse practitioner to his staff in order to bear the added burden of taking new patients into his existing pool of approximately 3,500. Smith-Blackwell has a nurse practitioner on her staff as well and is looking to add another.

Getting doctors into local population centers is difficult enough, but rural areas are even worse off when it comes time to draw in a doctor. Getting access to a doctor, finding a way to get there and being able to afford the treatment are all components that need to be addressed in a permanent solution, Smith-Blackwell said. But for the time being, doctors will have to make adjustments to meet the area’s demands.

“With doctors who are looking to slow down and retire, we want to make sure that continuity of care remains,” Wadhwa said. “Hospitals are trying to step up and get doctors to the area, but a lot of factors are out of our means.”

Contact reporter Daniel Pyeat 693-1000, ext. 158.

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