Family Physicians Face Hard Economic Times Head-on

Is the turndown in the U.S. economy impacting America's family physicians and their patients? You bet it is -- and in a multitude of ways.

"What we're seeing in the office is patients are generally coming in sicker," said solo FP Linda Stewart, M.D., of Baton Rouge, La. "It really stresses the office when you're having to rush several (patients) off to be admitted (to the hospital)," she added.

At the same time, said Stewart, her practice is experiencing an overall decrease in patient volume. She used to see nearly 30 patients a day, but that number has dropped to about 20 a day. And she's spending more time with patients as she assesses their stress levels and fields questions about whether medical tests will be covered by their insurance. "It's probably increased the length of the visit by 10 percent," said Stewart.

Patients' attitudes about prescriptions also have changed. "If they can't get a $4 generic drug from Walmart, they don't want it," said Stewart, who added that she's also getting more phoned-in prescription requests from patients who are past due for appointments.

Ditto for Deborah Sutcliffe, M.D., of Red Bluff, Calif. She said she's had patients cancel a follow-up appointment for a chronic condition in one breath and request a prescription refill in the next. The lapses in medication are taking a toll on patients' health.

"I've seen a lot of people stop using their asthma medications because they're so expensive," said Sutcliffe. Too often, those patients end up on steroids or hospitalized, she added. When patients with diabetes stop taking their medications, their hemoglobin A1c skyrockets, she said.

"We're seeing a lot more exacerbations of chronic problems in the ER," said Sutcliffe, noting that ER admissions in her local hospital are up, even as the number of elective surgeries has dropped precipitously. "In the ER last year at this time, they were running about 80 patients a day, and for the past three months, it's been almost a 100 or more patients every day," she said. "And yet we actually have two more primary care physicians in the community than we did a year ago."

Sutcliffe, who offers open-access scheduling, said patients tell her they go the ER for health care because they can't afford the health insurance copay for an office visit. Sutcliffe's solo practice is located in Tehama County, which has an unemployment rate of more than 14 percent.

The experiences reported by Stewart and Sutcliffe mirror statistics captured in a recent AAFP survey aimed at gauging the recession's impact on FPs and their patients. According to the survey results

Of the 505 FPs who participated in the online survey, 44 percent said financial stresses were affecting their practices and forcing them to consider cutting patient services or reducing staff.

In an AAFP press release announcing the survey results, AAFP President Ted Epperly, M.D., of Boise, Idaho, said that the survey provided evidence that consumers often defer health care during a recession. Health care is the largest sector of the economy, and people get sick no matter what's happening on Wall Street, said Epperly. He added that the health care industry suffers, as well, when some families are forced to prioritize rent or mortgage payments and food over health care services.

The biggest economic hit taken by Thomas Horton, M.D., a solo FP in Rainsville, Ala., has been the loss of patients with private insurance.

"Where we're really hurting is the 25 percent of the practice that was private Blue Cross insurance, largely provided by the sock mills," he said. Those mills kept the local economy strong for 100 years, but most have moved overseas in a troubling trend that was well under way before the latest economic turndown.

Horton said he's seeing an uptick in people wanting pain medications, sleep aids and antianxiety drugs. He attributes the surge to an increase in patients' stress levels, possibly due to the poor state of the local economy.

Not surprisingly, Horton is stressed, too. "I'm operating without life insurance, without health insurance, and I had to get the phones turned back on two days ago because we couldn't pay the phone bill for a few hours," he said.

In Canton, Ohio, solo FP James Johns, M.D., is squeezed by layoffs and downsizing in the auto industry. Many of his patients work directly or indirectly in that industry and are losing their jobs and health insurance.

Johns worries about what the overwhelming stress is doing to his patients' health. He's also concerned about patients shoving their health care to the bottom of the priority list in what he calls the "downstream" effect.

"Down the road, if people don't control the risk factors they have, it may increase heart disease, strokes, kidney disease … because we may lose control of things we've worked diligently to get under control," he said.

Joshua Steinberg, M.D., practices in the Wilson Family Practice Residency in Johnson City, N.Y. He's staying plenty busy with the usual heavy load of indigent patients who have multiple health concerns. "Our patients have always had issues similar to (what would be expected as a result of) the current economic problems," said Steinberg, adding that the majority of his patients are on Medicaid.

However, Steinberg's practice is affiliated with a larger health care organization that operates multiple practices and a hospital that has seen a drastic decline in admissions. Steinberg worries that the larger organization's financial distress may trickle down to his practice.

"There might be some changes. We're being told we have all these big deficits and that every office has to improve how they're doing (financially)," said Steinberg.

"We all have added additional office hour slots to our schedules, but the organization is still looking at productivity and expenses critically," said Steinberg. "I'm just going to be calm and patient and confident that if we do our job, things will work out," he added.