Kent Treptow/The Olympian
Dr. Charlotte Clark-Neitzel (left) discusses neck exercises and posture Thursday with patient Stefany Lontz, 12, at Sea Mar Community Health Clinic in Lacey. Sea Mar is just one of the area health institutions affected by the closing of Memorial Clinic -- which employed 74 physicians -- seven weeks ago.

No one sees quick cure for doctor shortage

County ERs seeing record number of patient visits

LORRINE THOMPSON, THE OLYMPIAN

"You're going to see quiet bankruptcies now. Nobody is going to shoot off a flare gun when they leave." -- Dr. Curtis Edwards, president, Thurston Mason Medical Society, on the potential for more doctors leaving South Sound

Originally published August 19, 2001

THURSTON COUNTY -- Joanne Barker of Olympia finally found a doctor who would accept her Medicaid insurance. But she had to go to Seattle to do it.

"It is hard to get a primary care doctor" in Thurston County, said Barker, 46, of Olympia. The mother of three lives on about $600 a month because her health problems keep her from working.

Barker is one of thousands of Thurston County residents struggling to find appropriate health care.

Seven weeks after the closing of the 74-physician Memorial Clinic, county emergency rooms are setting records for patient visits, and health experts worry that the primary care crisis will worsen long before it improves.

Not only is there a shortage of physicians, but many of those who are practicing here have stopped accepting government insurance such as Medicaid, government coverage for low-income patients, and Medicare, which serves senior citizens.

"I foresee losing another half-dozen doctors in the next 20 months, and that's conser-vative," said Dr. Curtis Edwards, president of the Thurston Mason Medical Society.

"I foresee that because nothing substantial has changed in (insurance) reimbursements," he said.

Thurston and Mason counties already have lost nearly 50 doctors in two years, a large portion of them primary care doctors, according to medical society records.

Physicians and clinic administrators say low insurance payments for health care, particularly in government programs, and mounting administrative costs are forcing them to close their practices entirely or at least to patients with some insurance plans. In some cases, physicians are leaving South Sound or Washington for more lucrative places to practice.

In June, health officials said they hoped the county's health care problem had hit bottom with the closing of Memorial Clinic. But since that time, "nothing has changed," said Joe Sharp, chief executive officer of Capital Medical Center.

"It's still a constant battle," he said.

Doctors in scarce supply

The number of people streaming into Providence St. Peter Hospital's emergency room for care continues to set records.

In July, 4,865 people visited the St. Peter ER, 847 patients more than in July 2000, and 415 more than in June. That means that in July 2001, the ER treated an average of 157 patients a day -- or 27 more each day -- than the year before.

But the hospital began setting records for emergency room visits in January, as family physicians began to leave the area.

"It's a strain, but we're managing it," said Brad Massey, emergency department manager.

Emergency rooms are busy throughout the region, he said, but "we've had this extra volume that the other ERs aren't seeing."

Massey estimates that the closure of Memorial Clinic and the flight of doctors are responsible for about 10 additional patients per day.

Many of those coming to the ER are patients who have insurance but no doctor, Massey said. "There do seem to be a lot of people up in the air," he said.

Need for specialists

Capital Medical Center's emergency room staff "is definitely busier than they've ever been," said Dr. Cynthia Wolfe, director of emergency services.

What's more disconcerting than the volume of people is that the staff is having a hard time finding doctors to treat Medicaid patients who need specialists, Wolfe said.

A man with a severe hand laceration came to the ER recently, and a Seattle physician was the only specialist Wolfe could find to provide follow-up care. The man told Wolfe he could not get to Seattle.

"I felt so horrible. I felt caught and legally liable," Wolfe said.

People without options will ask for follow-up appointments at the emergency room.

"Emergency rooms are not clinics, and yet we're being asked to function as one," she said.

The problem is not limited to emergency room workers.

"We're having trouble getting children referred to specialists," said Dr. John Karpel, a pediatrician.

He recently tried to find an ear, nose and throat specialist to help a girl with Medicaid coverage who had fractured her nose. The only ear, nose, and throat practice in Thurston County closed to new Medicaid patients in the spring, as did practices in Pierce County.

"I spent 40 minutes on the phone with Children's (Hospital in Seattle), and I finally got her into Children's," Karpel said.

Medicaid refusals understandable

Wolfe said she understands why physicians are refusing to accept Medicaid: The seriously low pay can jeopardize medical practices, and the state recently adopted an aggressive new auditing program to detect billing errors, including the threat of prosecution.

"That's what tipped over the docs," Wolfe said of the state's Payment Integrity Program.

"But the result of that is terrible," she said.

Sea Mar Community Health Clinic in Lacey gets 50 to 75 calls a day from people who don't have physicians and are looking for care, said clinic Manager Tina Olson.

"A lot of panicky people looking for providers. A lot of angry people when they call. They've already called around by the time they call us," Olson said.

Calls to the Thurston Mason Medical Society seeking physician referrals have not leveled off, said Executive Director Susan Peterson.

"We're still getting lots of calls, probably as many as we did before," Peterson said.

Callers primarily have Medicaid and Medicare insurance, but calls from people looking for pediatricians also have increased, she said.

Health officials hoped that once Memorial Clinic closed and its doctors reorganized into new practices, new slots for patients would materialize.

"That reorganization didn't seem to open up any additional practices that I know of," Peterson said. "We just have so few physicians that accept Medicaid, and now Medicare."

From outcry to quiet desperation

Now that the demise of a large clinic like Memorial has stopped grabbing attention, doctors worry that the medical care crisis will become invisible again, allowing the community's health care system to slowly deteriorate further.

"Nothing has changed. It's just gotten quieter," Edwards said. "You're going to see quiet bankruptcies now.

"Nobody is going to shoot off a flare gun when they leave."

Doctors won't continue to complain loudly to the government, he said.

"I think that the doctors feel they've told their story, and that there's generalized indifference from our representatives," he said.

Family physician Dr. Stephen Albrecht worries that the new practices that are being established will have a difficult time surviving financially.

"It wouldn't surprise me if the financial situation of a lot of these new practices is much more tenuous than mine," he said.

Albrecht said he's also concerned about the short-term effect on the community if even a few doctors don't make it, and the long-term effect of a nationwide trend that shows fewer doctors choosing to practice family medicine.

Capital Medical's Sharp said he's worried enough about the future to wonder if a single-payer health care system, also called universal health care, might be the answer. A year ago, Sharp said, he would never have considered such a notion.

"I'm starting to think that's the only solution," he said. "Maybe I'm going to have to be one of those who goes over to the other side. Things are going to get worse. There are too many people being left behind."

Try, try again

Doctors and health officials are not giving up, however.

The Washington State Medical Association and county medical societies are considering asking state officials to bring Medicaid payments at least up to the level of Medicare payments.

The medical association also will present a report at its annual meeting in September, listing alternatives for financing the health care system.

Physicians' offices, Capital Medical Center and St. Peter continue to recruit physicians to the area -- Albrecht's office will add a family doctor in September, and Capital Medical recently recruited a new family physician and three specialists to the area.

Medical, hospital and insurance associations continue to lobby state and federal lawmakers, hoping to get changes made in reimbursements and administrative requirements.

Edwards hopes legislators listen and act soon.

"This is not a situation that's going to bear a lot of study," he said. "Physicians have made up their minds. They have to be able to make a living. They have to pay for that 27 years of schooling."

Lorrine Thompson covers health care and Thurston County government for The Olympian. She can be reached at 360-754-5431.

More coverage

Today's story is the first of two stories updating Thurston County's health care crisis. Next Sunday, The Olympian will examine what state and federal officials are doing to remedy the situation.

Health care forum Aug. 30

Southwest Washington's two Congressmen will be in Olympia on Aug. 30 for a forum focused on access to health care. Rep. Brian Baird and Rep. Adam Smith will participate in "Health Care in Crisis: A Conversation With Our U.S. Representatives," from 5:30 to 7 p.m. at The Olympia Center, 222 N. Columbia St.

The public is encouraged to attend. There is no charge. The session is sponsored by the Building Communities project, a media partnership involving The Olympian, KGY radio and Thurston Community Television.

"Our May 30th forum with the two U.S. senators was very well received by the community, and it's important for our representatives in Congress to understand the depth of the health care crisis in South Sound," said Mike Oakland, editorial page editor at The Olympian and one of the organizers.

"Congressmen Baird and Smith have agreed to a full hour of questions from the audience and will respond to any unanswered questions in writing," Oakland said. "The timing for this community forum couldn't be better. The two representatives will return to Washington, D.C., and get right to work setting the nation's health care budget for the coming year."

The Olympian Copyright 2001

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