Family Physicians Regain Toehold in Storm-Devastated Gulf Coast
By Leslie Champlin
5/15/2006
As the 2006 hurricane season approaches, family physicians continue to be at the forefront of resuscitating the Gulf Coast health care system, which was devastated by Hurricane Katrina. Progress remains tenuous, however, as FPs work to rebuild practices and their patient censuses.
As family physicians begin to open their practices in the Gulf Coast area, free medical clinics, such as Camp Coast Care, which is operated by the Episcopal Diocese of Mississippi, help to fill in the health care gaps.
Family Physicians Returning
Family physicians have been among the point men and women in the hurricane recovery effort. Today, 85 percent of Mississippi AFP members are open for business, according to a survey conducted this spring by the Mississippi AFP. However, 2 percent of the chapter's members report their practices were destroyed by the storm and will not reopen. And, as of March, no physician had returned to particularly hard-hit Bay St. Louis, Miss., or Waveland, Miss., according to a report by Mississippi AFP President Luke Lampton, M.D., of Magnolia, in the spring issue of Mississippi Family Physician.
Meeting hurricane survivors’ health care needs is especially complex in an economy that is still reeling from the storm's effects. Family physicians who have reopened their office doors grapple with issues such as caring for patients who have no jobs or insurance, uncollectible accounts-receivable, and staff vacancies -- not to mention escalating psychological issues among patients.
“Getting the clinics functioning again has not been easy,” said Lampton in his report. “… massive delinquent accounts-receivable demoralize many of the Coast physicians” who have stopped sending bills because their patients' addresses no longer exist. “Also, many of the patients … have lost their places of work and their jobs and, thus, their health insurance.”
As a result, 67 percent of Mississippi AFP members struggle with slow payment and 48 percent continue to provide uncompensated care.
Thirty percent of practices that are open have a patient load of 50 percent of normal or less, although the survey found that 34 percent have a full patient load. Some patients don’t know their doctor's office is open, and for those who do, health care sometimes comes second to putting a roof over the family's heads.
“People are beginning to drift back,” said Robert Terrell, M.D., of Ocean Springs, Miss. “But when it comes to deciding whether to see the doctor or buy Sheetrock to rebuild, Sheetrock takes priority. We’re close (to the worst-affected areas), but if patients want to see a doctor, they have to drive 50 miles. And now the price of gas is getting us.”
Distance also affects physicians’ ability to staff offices and identify subspecialists to whom they can refer patients. Administrative, nursing and other employees must commute from their temporary homes to the hurricane-devastated region where physicians are rebuilding. Twenty-four percent of Mississippi AFP members who have reopened report they are recruiting staff members.
“My office is trying to hire two new employees,” said Delora Denny, M.D., of Picayune, Miss. The Federal Emergency Management Agency, or FEMA, “has taken a large proportion of the workforce because they are paying more than the private sector now.”
Likewise, subspecialists have moved -- either temporarily or permanently -- from the region. Across the Gulf Coast, several family physicians have reported problems finding surgeons, cardiovascular suspecialists and others to whom they can refer patients when necessary.
“The number of subspecialists is getting a little thin,” said Paul Pavlov, M.D., of Biloxi. “We continue to remain busy, but part of that is because the doctors have moved away. It could slow down if they come back, but some will relocate permanently; they may not come back.”
One Doctor’s Story
Among FPs who returned to rebuild is Ben Kitchings, M.D., of Long Beach, Miss. He and his wife fled their hometown Aug. 27, 2005. They returned seven weeks later to concrete slabs where their house and his medical practice once stood.
Today, after cobbling together some basics for a medical office, Kitchings is seeing patients in a four-room house donated by his church. Two former bedrooms serve as examination rooms; the living room-dining room area serves as the reception area and office. A small kitchen stores basic medical supplies.
“I provide a lot of charity care, and I got a couple of grants that totaled $30,000 to pay expenses and get supplies,” said Kitchings. He also helps his unemployed and uninsured patients by providing medication samples, “though most of the pharmaceutical representatives don't know where we are yet.”
In the nine months since Hurricane Katrina, Kitchings’ patient load has slowly increased as more people realize he survived the storm and that his practice is open. “Some days, I’m seeing as many patients as before the storm,” he said.
Ongoing Needs
Patients’ ongoing needs are significant, say researchers. A February survey of individuals and families housed in FEMA-subsidized trailers or hotels found that 44 percent lacked health insurance, and nearly half had at least one chronic medical condition.
The survey, conducted by the Columbia University School of Public Health, New York, N.Y., and the Louisiana Department of Public Health, also found that more than one-third of children in FEMA housing had at least one chronic condition that required medical management. Compared with children surveyed in urban Louisiana in 2003, children displaced by the hurricane “are more likely to suffer from asthma, behavioral or conduct problems, developmental delay or physical impairment, and learning disabilities.”
Moreover, numerous studies show that mental health issues afflict significant numbers of hurricane survivors. Given a mental health screening as part of the Columbia University survey, more than half the women scored at levels "consistent with clinically diagnosed psychiatric problems, such as depression or anxiety disorders."
Family physicians’ experiences give life to those data.
"I’d say one in five or six patients each day has a psychological complaint that’s storm related," said Pavlov. "I’ve had five cases of post-traumatic stress disorder today."
The toll is greatest on the elderly, said physicians.
"I’m seeing more and more of my patients’ names in the obituaries every week," said Terrell. "They’re giving up and dying. When you’re 80 years old and you’ve lost everyone and everything, you have no reason to live."
Family physicians have been among the point men and women in the hurricane recovery effort. Today, 85 percent of Mississippi AFP members are open for business, according to a survey conducted this spring by the Mississippi AFP. However, 2 percent of the chapter's members report their practices were destroyed by the storm and will not reopen. And, as of March, no physician had returned to particularly hard-hit Bay St. Louis, Miss., or Waveland, Miss., according to a report by Mississippi AFP President Luke Lampton, M.D., of Magnolia, in the spring issue of Mississippi Family Physician.
Meeting hurricane survivors’ health care needs is especially complex in an economy that is still reeling from the storm's effects. Family physicians who have reopened their office doors grapple with issues such as caring for patients who have no jobs or insurance, uncollectible accounts-receivable, and staff vacancies -- not to mention escalating psychological issues among patients.
“Getting the clinics functioning again has not been easy,” said Lampton in his report. “… massive delinquent accounts-receivable demoralize many of the Coast physicians” who have stopped sending bills because their patients' addresses no longer exist. “Also, many of the patients … have lost their places of work and their jobs and, thus, their health insurance.”
As a result, 67 percent of Mississippi AFP members struggle with slow payment and 48 percent continue to provide uncompensated care.
Thirty percent of practices that are open have a patient load of 50 percent of normal or less, although the survey found that 34 percent have a full patient load. Some patients don’t know their doctor's office is open, and for those who do, health care sometimes comes second to putting a roof over the family's heads.
“People are beginning to drift back,” said Robert Terrell, M.D., of Ocean Springs, Miss. “But when it comes to deciding whether to see the doctor or buy Sheetrock to rebuild, Sheetrock takes priority. We’re close (to the worst-affected areas), but if patients want to see a doctor, they have to drive 50 miles. And now the price of gas is getting us.”
Distance also affects physicians’ ability to staff offices and identify subspecialists to whom they can refer patients. Administrative, nursing and other employees must commute from their temporary homes to the hurricane-devastated region where physicians are rebuilding. Twenty-four percent of Mississippi AFP members who have reopened report they are recruiting staff members.
“My office is trying to hire two new employees,” said Delora Denny, M.D., of Picayune, Miss. The Federal Emergency Management Agency, or FEMA, “has taken a large proportion of the workforce because they are paying more than the private sector now.”
Likewise, subspecialists have moved -- either temporarily or permanently -- from the region. Across the Gulf Coast, several family physicians have reported problems finding surgeons, cardiovascular suspecialists and others to whom they can refer patients when necessary.
“The number of subspecialists is getting a little thin,” said Paul Pavlov, M.D., of Biloxi. “We continue to remain busy, but part of that is because the doctors have moved away. It could slow down if they come back, but some will relocate permanently; they may not come back.”
One Doctor’s Story
Among FPs who returned to rebuild is Ben Kitchings, M.D., of Long Beach, Miss. He and his wife fled their hometown Aug. 27, 2005. They returned seven weeks later to concrete slabs where their house and his medical practice once stood.
Today, after cobbling together some basics for a medical office, Kitchings is seeing patients in a four-room house donated by his church. Two former bedrooms serve as examination rooms; the living room-dining room area serves as the reception area and office. A small kitchen stores basic medical supplies.
“I provide a lot of charity care, and I got a couple of grants that totaled $30,000 to pay expenses and get supplies,” said Kitchings. He also helps his unemployed and uninsured patients by providing medication samples, “though most of the pharmaceutical representatives don't know where we are yet.”
In the nine months since Hurricane Katrina, Kitchings’ patient load has slowly increased as more people realize he survived the storm and that his practice is open. “Some days, I’m seeing as many patients as before the storm,” he said.
Ongoing Needs
Patients’ ongoing needs are significant, say researchers. A February survey of individuals and families housed in FEMA-subsidized trailers or hotels found that 44 percent lacked health insurance, and nearly half had at least one chronic medical condition.
The survey, conducted by the Columbia University School of Public Health, New York, N.Y., and the Louisiana Department of Public Health, also found that more than one-third of children in FEMA housing had at least one chronic condition that required medical management. Compared with children surveyed in urban Louisiana in 2003, children displaced by the hurricane “are more likely to suffer from asthma, behavioral or conduct problems, developmental delay or physical impairment, and learning disabilities.”
Moreover, numerous studies show that mental health issues afflict significant numbers of hurricane survivors. Given a mental health screening as part of the Columbia University survey, more than half the women scored at levels "consistent with clinically diagnosed psychiatric problems, such as depression or anxiety disorders."
Family physicians’ experiences give life to those data.
"I’d say one in five or six patients each day has a psychological complaint that’s storm related," said Pavlov. "I’ve had five cases of post-traumatic stress disorder today."
The toll is greatest on the elderly, said physicians.
"I’m seeing more and more of my patients’ names in the obituaries every week," said Terrell. "They’re giving up and dying. When you’re 80 years old and you’ve lost everyone and everything, you have no reason to live."
Health of the Public
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