'Perfect storm' leads to Midcoast physician shortage

By Kim Lincoln | Nov 30, 2015
Photo by: Kim Lincoln Erik Frederick, chief operating officer at Pen Bay Healthcare, discusses the shortage of primary-care providers.

Fewer people pursuing a career in primary care and an aging population — both in terms of the people needing health care and those working in health care — are to blame for a shortage of primary-care physicians nationwide and in the Midcoast.

"It's a perfect storm sort of situation that we are trying to address," said Erik Frederick, chief operating officer at Pen Bay Healthcare.

Laurie Doran, 54, of Camden, found herself looking for a new family doctor after her physician of 30-plus years, Dr. McKim Peterson, retired in September. She quickly learned it was not as simple as making a phone call or logging onto the Find a Doctor page on the Pen Bay Healthcare website.

Prior to retirement, Peterson practiced out of Midcoast Medicine in Rockport. When Doran received a letter from Midcoast Medicine asking patients to submit paperwork to transfer their files to the practice's new Camden office, Doran assumed this meant she was still a patient with Midcoast Medicine.

It was not until she tried to make an appointment that she discovered the practice was not absorbing all of Dr. Peterson's patients.

"I'm thinking they've got my forms, they've got my files, I should be all set, but that is when the nightmare began," Doran said.

Doran, who is retired, spent almost three days calling various doctors she found on the Find a Doctor page on the Pen Bay website. She called nearly 50 doctors and very few were accepting new patients — some had waiting lists in the hundreds and others could not take on any new patients until at least March 2016.

Doran's situation is not unusual, according to Frederick. "We definitely hear it all the time [and] in all settings. Not a day goes by that one of us does not hear from a consumer; an employee will hear it at the supermarket," said Frederick.

Maine has the highest median age, 42.7, of any state and Knox County has the third-highest population (22.4 percent) of residents above the age of 65, behind Lincoln (25.3 percent) and Piscataquis (23.6 percent) counties, according to the latest data from the U.S. Census.

With the aging of the baby-boom generation, there has been a surge of people accessing the health-care system. At the same time, nationwide, fewer doctors are pursuing primary care as a career, choosing instead to go into more specialized fields, Frederick said.

"Because of this, what happens nationally, locally, and in the state is that everyone wants these physicians, so the competition is fierce," Frederick said.

Concurrently, the few practicing primary-care physicians available are seeing their patient population grow significantly. Frederick said doctors have what he called a “panel,” which is the largest number of patients a medical provider can be accountable for and still ensure good care in a timely way. When the panels grow, there is less time with patients, Frederick said.

And, as Doran discovered, one way providers control the size of their panels is to stop accepting new patients.

Doran said she found one doctor taking patients, but not until May. Another practice told her to fill out some paperwork and they would interview people early next year to decide which patients they would accept. "So now I have to audition?" she said.

Since she is on management medications that must be taken daily, she could not wait that long to be seen.

In frustration, Doran took to social media to vent about her situation. She found she was not alone. In just a few hours, more than 50 people had sent her private messages and another 28 people had openly commented on her post, many with similar stories.

After seeing her Facebook post, a representative from Pen Bay contacted her, attempting to help, but later called back and said she also could not find her a doctor, she said.

"Imagine if you didn't have a computer or if you were elderly [trying to find a doctor]," Doran said. "Imagine, imagine, imagine."

Frederick said Pen Bay has seen a few people come into the emergency room who lost their primary care provider and have run out of their medications. During the summer, the Pen Bay Medical Center emergency room saw an increase in visits, but so far projected visits versus actual visits for the entire year are not far off from what was anticipated, he said.

"I absolutely understand the fear ... we are working on this very situation," he said, noting hospital management has been meeting with the ER director to discuss the problem.

At Pen Bay Healthcare, officials have been using physician assistants and nurse practitioners in place of traditional family doctors. However, since there is a nationwide trend toward the use of PAs and NPs, the competition for them is also very high.

"Although that is becoming a more popular model and people are beginning to pursue those options, everyone wants them because it is another option," he said. "It's driving competition, but it's also driving cost."

Pen Bay is also pursuing locum tenens, or temporary, physicians that serve a three- to six-month stint.

"They can be very helpful, but in primary care it's not the most ideal situation because you're not really building that relationship you expect with your primary-care provider," he said.

Frederick said locum tenens physicians also are in high demand and Maine currently has 11 requests out for temporary internal medicine doctors.

Since 2014, Pen Bay Healthcare has experienced changes in several of its practices, which has further compounded the situation, he said. In some offices, doctors have left unexpectedly and left patients without physicians.

At Pen Bay Internal Medicine, Dr. Archibald Green left in 2014 and staff shuffled to figure out how to absorb his patients while Pen Bay Healthcare began the recruitment process. Then, this summer, Dr. Denise Anderson made the decision to leave the same office and move into hospitalist services.

Frederick noted Anderson is a great doctor and the hospital is very grateful she made the switch because it was a needed service, but it left a hole of two physicians in one office. Dr. Lori Tobler was then recruited to take on some of those patients, but she also decided to leave. Nov. 20 was her last day.

On the family medicine side, Peterson closed his practice in September and Dr. Brian Pierce, who also worked at Midcoast Medicine, also left to open his own cash-only practice.

"The other reality is, in our region and many others, we have a number of our primary-care providers looking at retirement," Frederick said. In September, Drs. Ted Mohlie and Jack Waterman, who work at Waldoboro Family Medicine, started scaling back and decreasing their patient loads so they can eventually retire.

"So it's kind of coming from all angles,” Frederick said. “It's internal and some of the things we are doing, it's external practice environment and what people are doing out there. It's folks just saying, 'hey, it's time to retire.' It's the diminishing pool of resources," he said.

Pen Bay Healthcare is actively recruiting for internal medicine and family medicine physicians, and family and adult nurse practitioners, he said.

The organization also is looking at establishing a clinic in Rockland, with the former MacDougal School lot on Broadway and a site on Tillson Avenue as possible locations. The idea is for a clinic that would include pediatric and general practice doctors' offices, as well as a dental care office.

Frederick acknowledged it is often challenging to find a building suitable for health care because there are a lot of regulatory requirements related to things like the level of air conditioning and fire safety. Often there is so much work to be done to an existing building, he said, that the work exceeds the value of the building and constructing a new building is more affordable.

Pen Bay Healthcare is also trying to help its current staff of medical providers. One initiative is consolidating the various practices scattered around Rockport into a new primary services building on the Pen Bay Medical Center campus. “The vision is to better support staff by being co-located, getting some efficiencies by being in one place, which would give employees better work flow," Frederick said.

Frederick said the hospital is in the design phase and also looking at funding options for the new building.

Doran was eventually able to find a spot at Seaport Community Health Center in Belfast, but cannot be seen until January.

"I did find someone. I do have to drive and I do have to wait eight weeks. That's the best I can do," she said. "I think what is most disheartening is, I've lived here 54 years, four generations, and never left town and I can't find a doc?"

Courier Publications Editor Kim Lincoln can be reached at 236-8511 or by email at klincoln@villagesoup.com.

Comments (15)
Posted by: Maggie Trout | Dec 02, 2015 15:30

What percentage of patients listed on the panels are seasonal?  As any year-rounder knows, getting appointments in the springtime can be extremely difficult, whether here in the midcoast, or in Portland, because snowbirds and summer visitors make their appointments one year in advance.  When they are not here, are those maximum patient loads adjusted.  If they are not, then at least some care could be provided in the interim, right?



Posted by: Maggie Trout | Dec 02, 2015 12:05

You're saying that all physicians accept MaineCare?  Consumers must be surprised to learn that fact.  How much physician time is spent recoding rejected Medicare and MaineCare claims.  Or, if rejected, is an unauthorized person permitted to alter the coding, and, potentially, the diagnosis and treatment plans, or is this done by physicians who must review a patient visit notes, tests, and results. 



Posted by: Jen Harris | Dec 02, 2015 11:08

Pen Bay fully participates in Medicare and MaineCare. Any physicians employed by Pen Bay bill to both of these programs.



Posted by: Brian Pierce | Dec 01, 2015 17:00

We're moving our growing practice to bigger quarters and have started the search for the right physician to join us next year.

All of the national problems with primary care and many of our local issues are directly or indirectly related to the crazy way we pay for routine primary care.   When you simplify that, primary care becomes affordable again for most patients and a better career choice for young physicians.

Brian Pierce MD

Rockport



Posted by: Ronald Horvath | Dec 01, 2015 14:29

It may be the new norm but a return to an unregulated market would also mean a return to an old norm, one in which the top levels of society got the best health care and the rest of us got second best or nothing at all.  Market values have nothing to do with health care.  It is a necessity, not a commodity.  People cannot choose whether or not to get sick just as they cannot choose to simply do without it.  A free market in health care would bring back that old norm of most people not being able to afford health care at all resulting in a return to a life span of around thirty-five, a majority of children dying before their fifth birthday, and woman dying in childbirth.  Ironically, the number of doctors that could live well off the economic elite that could then afford them would be even more restricted and the great hospitals and medical institutions we now point at with pride would become far and few between.  As it always does a capitalist free market in health care would destroy it for all while preserving it only for the elites.



Posted by: Lori Maxwell | Dec 01, 2015 11:30

Dale is on point . You have a large demand ( patients) and limited supply ( doctors ). in a normal world it would mean that the price would rise and that would draw more people to become doctors. But because everything including the price being paid to primary care doctors is highly regulated you do not get a normal market reaction. What you get is that the compensation to doctors is too low and therefore people simply do not go into that filed in sufficient numbers. Get used to having a PA or Nurse practitioner . It will be the new norm. David Maxwell



Posted by: Bruce Hodsdon | Dec 01, 2015 08:56

Seems there are many reasons why doctors are leaving this area. I wonder if other hospitals are having the same problem. If they are not, then why are doctors leaving the Pen-Bay system? Did the reporter talk with any doctors who have left to find out why? Has the failure of Maine to accept added Medicaid funding contributed at all? What is really being done other than building another medical building, which Pen-Bay seems to constantly be doing instead of providing better quality care.



Posted by: Ronald Horvath | Dec 01, 2015 08:47

More misinformation from your favorite conservative "think" tank, Dale?  You've even gotten the amount wrong.  They didn't tell you there'd be math, did they.

 

From Politifact:

 

"In a few cases, the law actually increased Medicare spending to provide more benefits and coverage, according to the Kaiser Family Foundation, a trusted independent source that analyzes the health care system. For instance, the health care law added money to cover prevention services and to fill a gap for enrollees who purchase prescription drugs through the Medicare Part D program. (That coverage gap is often referred to as the doughnut hole.)

Other parts of the law are intended to reduce future growth in Medicare spending, to encourage more efficiency and to improve the delivery and quality of care. (An example is paying hospitals less when patients are quickly re-admitted to hospitals after being discharged, to prevent people from being discharged too soon.)

The bill doesn't take money out of the current Medicare budget but, rather, it attempts to slow the program's future growth, curtailing just over $500 billion in anticipated spending increases over the next 10 years. Medicare spending will still increase, however. The nonpartisan Congressional Budget Office projects Medicare spending will reach $929 billion in 2020, up from $499 billion in actual spending in 2009.

So while the health care law reduces the amount of future spending growth in Medicare, the law doesn't cut current funding for Medicare."


http://www.politifact.com/truth-o-meter/statements/2011/sep/12/michele-bachmann/did-president-obama-steal-500-billion-medicare/



Posted by: Dale E. Landrith Sr. | Dec 01, 2015 08:00

A major contributor to the problem is the federal government attempting to manage healthcare.  We have an aging population (me included) and thus Medicare and Medicaid are a major source of medical patients.  In these programs the feds have been constantly trying to reduce the payments to medical providers.  In Obamacare $500,000 was removed from funding Medicare.  We were warned over and over that fewer doctors would be available as many would retire and new folks entering the medical profession would be fewer as a result of the greatly reduced financial incentive for new doctors.  The perfect storm was substantially aided by the feds.



Posted by: Laurel E Taylor | Dec 01, 2015 06:53

Part of the problem here is that a large amount of local doctors (grouped at PBMC) will not bill Medicare or Maine care, this leaves elderly patients in a real mess. I was able to stay with Midcoast medicine because I had seen another doctor in the practice. My elderly brother on the other hand could not, I was lucky to find him one in Waldoboro.



Posted by: Maggie Trout | Nov 30, 2015 15:53

Is Pen Bay Medical Center/Maine Health certified for the National Health Service Corps.  (That is the program that provides loan reduction for physicians willing to service in underserved areas).  If not, the next certification cycle begins in the spring.



Posted by: Maggie Trout | Nov 30, 2015 15:33

Ms. Doran believed MidCoast Medicine was providing continuity of care. Given Ms. Doran's needs for medication mangement, isn't there a responsibility on the part of the practice to provide sufficient care so that she can continue to receive her medications through that practice.  (The Midcoast Medicine website does not indicate that Dr. Peterson has retired; only that he is not accepting new patients). Troubling, too, is that Doran's medical records were sent to a dead end.  As to PenBay securing clinical staff, what is the availability of Nurse Practitioners.



Posted by: Lee H. Marshall | Nov 30, 2015 15:20

Three generations of our family saw Dr. Cox as our primary care physician before Dr. Peterson took over his practice. Now we had to scramble to find a new doctor. My Dad was lucky enough to be kept at the new office, but I was not so fortunate. I also thought the new practice would take me, considering the years there as a patient, but was wrong. It was extremely frustrating trying to find a new doctor, who was close enough so I did not have to travel. After days of making phone calls, I was fortunate enough to find a new primary care physician. Now I have to start all over again and imagine it will take a few visits for her to get to know me and my family history.

 

I wish others with this same problem the best of luck. Just do not give up.

 

Lee D. Marshall



Posted by: Sandra Schramm | Nov 30, 2015 15:15

Laurie, thank you for started such a much needed discussion and realization for Knox County residents. It is a crisis and hopefully PBMC will start to keep residents informed. Many health insurance changes coming along in 2016 as well. Good Luck.



Posted by: Maggie Trout | Nov 30, 2015 13:48

And then who will staff the clinic in Rockland.



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