Maryland residents looking for a primary care doctor have a harder task every day, as the number of family doctors continues to shrink and those still practicing say they are squeezed for time and money by insurance companies and forced to shortchange patients.
"The patients don't know what's going on," said Dr. Lindiwe Greenwood, a solo practitioner in Columbia. "They don't know why we won't take Medicaid."
She was among a group of doctors and other health care professionals who met recently to make recommendations to the General Assembly on how to address a growing crisis in this vital main link between patients and medical care.
FOR THE RECORD - An article in Thursday's editions incorrectly described the status of Erickson Health, a medical care practice with about 400 members in Columbia. The practice stopped accepting new patients in January and plans to cease operating July 1.
The Baltimore Sun regrets the error.
For every 1,000 new doctors who enter the primary care field each year in the U.S., 3,000 to 4,000 leave it, said Howard County health officer Dr. Peter C. Beilenson, who with County Executive Ken Ulman hosted the "primary care summit" to discuss the shortage.
With heavy loan repayment burdens that often are doubled by interest, medical students are increasingly opting for better-paid specialties or urgent care shift work that limits their work hours. Those who do become family physicians then face administrative costs that are so high and insurance reimbursements that are so low that some doctors have stopped dispensing vaccines because they lose money on every immunization, some of the speakers at the gathering said.
The 92 participants voted on a range of possible solutions, including a state-financed tuition program for medical students who choose primary care and agree to practice in Maryland for a minimum period of time, and tax deductions or bonuses to doctors who work in underserved areas or with uninsured patients. They also discussed how medical practices could band together in larger groups to provide leverage against insurance companies, and a requirement that insurance pay the same amount to every doctor for similar treatments.
"We don't want this to be just a bellyaching session," Beilenson said. "We want to do something about it."
The challenges faced by family physicians became starkly clear last October, when Dr. Harry Oken's primary care group practice in the county sent letters to its 10,000 patients announcing it was converting to a retainer- rather than insurance-based system. Known as "boutique" medicine, the practice said it would charge a flat annual fee in exchange for 24-hour access to doctors, longer appointments and the kind of care doctors say is impossible under insurance constraints. But the downside was that thousands of people who wouldn't or couldn't pay the $2,000 annual fee would have to find a new doctor.
