Storms' Impact Threatens Specialty's Future Along Gulf Coast

At a time when people need family physicians the most, the future of primary care along the Gulf Coast may be at risk. The impact of hurricanes Katrina and Rita on medical care in southern Louisiana and Mississippi will be long lasting, say many, as they survey the damage.

The storms not only ravaged the homes and offices of AAFP members, they also scattered physicians' patients across the nation, pushed patients who remained in the area onto unemployment rolls and deprived many of employer-based health insurance.

Hurricane Katrina directly affected 66 Mississippi family physicians in 44 practices, according to Beth Embry, Mississippi AFP executive director, who has been contacting members to assess the impact of the storm. Katrina damaged 25 clinics and destroyed two, according to Embry's figures. Eight members lost their homes. As of the first week of November, Embry still had not heard from a number of chapter members affected by the storm.

In the 16 Louisiana parishes declared Level 1 disaster areas by the Federal Emergency Management Agency, 724 primary care physicians were severely affected, according to a University of North Carolina at Chapel Hill study released in September.

The result: Family doctors across the Gulf Coast are trying to reopen damaged offices and struggling to keep them open, despite a dearth of patients and income.

"This was a complete loss of clinical infrastructure," said FP Lucius Lampton, M.D., of Magnolia, Miss. "All along the Mississippi coast up to Hattiesburg, we lost our billing capacity, our cash flow, our staff. Doctors have no money to pay employees or to buy new equipment or even paper forms" to replace what was destroyed.

Several colleagues -- particularly those who have practiced for decades -- have said they probably won't start over, according to Lampton. "They were practicing in a tenuous situation before, and now they can't start over," he said. "We're going to feel this storm's impact on the character of family medicine in that part of the country for a long time."

Moreover, many have been approached by recruiters asking about their interest in relocating in what FP Timothy Alford, M.D., of Kosciusko, Miss., called "physician looting."

Embry agreed. "We want to keep our doctors at home," she said, adding that much of the Gulf Coast already struggled with shortages in primary health care before the storms. Data indicate that, before the hurricanes, all but 20 Mississippi counties and all but 18 Louisiana parishes were classified as primary care Health Professional Shortage Areas by the Health Resources and Services Administration.

The numbers could become worse. The University of North Carolina at Chapel Hill study found Hurricane Katrina dislocated 5,944 physicians in active clinical practice. Of that number, 1,292 provided primary care.

"We don't know what this is going to mean to health care," said study author Thomas Ricketts, Ph.D., professor of health policy and administration at the UNC School of Public Health. The study analyzed data from the AMA's masterfile of physicians and FEMA-posted information. Ricketts also used information from Tulane and Louisiana State universities and from the Association of American Medical Colleges.

"We know from experience that some physicians will choose to retire, but we don't know how many," said Ricketts. "Likely, a very substantial number of physicians will permanently move away from the area."

Lampton agreed. Several physician colleagues already have relocated, he said.

"A lot of Mississippi doctors now have new jobs in Little Rock (Ark.)," he said. "I think the impact is going to be very significant. We're not really going to feel it for six months to a year."

Of equal concern is the future of family medicine education throughout the Gulf Coast. The storms scattered 1,300 medical students and 144 residents, according to FEMA. Those students and residents were relocated to programs in Baton Rouge and east Texas as well as to other programs in the region.

"Our doctors are preceptors for medical students, and we're trying to maintain our preceptor programs," said Lampton. "Most of our preceptors were in the area most affected by the storm."