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07/02/2005 Entry: "Arizona physician shortage acute in rural counties"
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By: Jessica Evans, The Independent
WHITE MOUNTAINS, ARIZONA
A recently released report shows that the number of Arizona physicians is below the national average and is not keeping pace with increases in the state's population.
In 2004 there were 208 doctors for every 100,000 people in Arizona. The national average is 283 physicians per 100,000 people. These findings were published in a report released by the W.P. Carey School of Business at Arizona State University and the University of Arizona Health Sciences Center.
Perhaps nowhere is that shortage more acutely felt than among women living the in White Mountains.
In January 2004, there were eight practicing obstetricians in the White Mountains. Those numbers have since dwindled to just two obstetricians delivering babies at Navapache Regional Medical Center, leaving hundreds of expectant mothers with little choice when it comes to their care.
Notices posted at University Obstetrics and Gynecology, asks that patients be patient when it comes to scheduling appointments as its two obstetricians - William C. Tindall, D.O. and Jeffrey C. Northrup, D.O. - have taken on the entire caseload for southern Navajo and Apache counties and Whiteriver IHS.
At NRMC, the 66-bed acute-care community hospital serving Navajo and Apache counties, there are more than 750 babies delivered each year.
NRMC Physician Recruiter Cindi Mortimer-Kies said the hospital is actively recruiting OB doctors and has signed a letter of intent with one OB/GYN.
"We're focusing right now on OB/GYN and pediatrics," she said. "Things are going really well in recruitment."
Mortimer-Kies said the hospital has successfully recruited five physicians who will join the staff by late summer or early fall. In addition to the one OB/GYN, NRMC has signed a letter of intent with one pediatrician as well.
NRMC's service area includes a population estimated to be around 70,000 with an estimated 5 percent growth each year.
"We have growing pains," Mortimer-Kies said.
The physician shortage problem has been evident for at least 15 years. Between 1990 and 2000, the physician/patient ratio per 100,000 Arizona residents dropped from 198 to 172.
Malpractice insurance premiums have skyrocketing in the last few years, a factor which is driving some obstetricians in Arizona out of business. Copper Queen Community Hospital and Douglas Hospital, both located near the Mexican borner, closed their maternity wards in the last few years because of staffing difficulties and high malpractice insurance rates.
Mortimer-Kies said that is not an option at NRMC.
"We want to provide healthcare to the community and that includes OB care," she said. "It's not in our strategic plan to do away with any services."
Arizona had 12,121 working physicians in 2004, the most recent year for which numbers are available, up from 8,026 in 1994. Those figures reflect a 51 percent increase from 1994 to 2004. Pima County, which has 277 doctors per 100,000 population, has the highest ratio in the state. The report also showed that 86 percent of Arizona's physicians practice in its two most populated counties, Maricopa and Pima.
Wade Kartchner, the new director of the Navajo County Public Health Services District, said physician population ratios in Arizona is a complicated issue.
"The state does have one of the lowest ratios in the U.S.," Kartchner said. "The national average of non-federal physicians engaged in patient care per 100,000 persons is 235. Arizona's number is 184. This number is not a true estimate of the physician ratio state-wide, because, as you know, the ratios vary greatly from county to county."
Kartchner said Apache County has the lowest ratio in the state with 49 doctors per 100,000 people and Navajo County comes in at about 73 doctors per 100,000.
There are a myriad of reasons for the lower ratios in Arizona, Kartchner said.
"First of all, rural communities in general throughout the United States have difficulty attracting physicians," he said. "Arizona, being quite rural in spite of Phoenix and Tucson, suffers from this disparity."
Other factors include the malpractice climate, AHCCCS reimbursements and the inability of rural Arizona health care organizations to compete with the large cities for physicians, Kartchner said.
"It does take someone with a certain mind set to practice away from the state-of-the-art hospital facilities and sub-specialists," he added.
NRMC Physician Recruiter Mortimer-Kies agreed. "We're just now busy enough to support a sub-specialist, we're just on the cusp," she said, adding that sub-specialities include pulmonology, gastroenterology and plastic surgery. "We'd hate to bring on, for instance, a gastroenterologist when we know we're not quite at that demand. We have to make sure that our general services are maintained at a certain level."
NRMC recently commissioned a study by AmeriMed Consulting to gauge its immediate and long-term physician needs. That study identified the areas in which NRMC needs to recruit additional doctors to fit the needs of the community. According to the findings, a total of 19 doctors in 13 specialities are needed at NRMC, including four internal medicine specialists, two OB/GYNs and two pediatricians. The hospital currently has 57 active physicians on staff.
Other specialities needing additional staffing include psychiatry, anesthesiology, cardiology, dermatology, gastroenterology, general surgery, hematology/oncology, orthopedic surgery, otolarynology and urology. NRMC is actively recruiting in eight of those fields.
Mortimer-Kies said the hospital has to plan not only to fill current gaps in medical service but also for the future departure or retirement of on-staff physicians. That planning, called succession planning, focuses on specialities in which practicing physicians are at or above the age of 55. NRMC currently has seven such fields including family practice, ophthalmology and podiatry.
Kartchner said there are programs in place to help attract doctors to remote and rural areas of Arizona. For one, he said, the state has medical school loan forgiveness programs for physicians who commit to practicing in rural areas of the state.
Mortimer-Kies said though the beauty of the White Mountain area helps to attract physicians, the relative geographic isolation and lack of services and retail comparable to that found in larger metropolitan areas can be a detriment to recruitment efforts.
"It has to be a match, and it's not always," she said. "We're doing a lot better than other rural areas. This is an unending endeavor, and we have to stay diligent."
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