AAFP Board Chair Warns Congress That H1N1 May Affect Physicians' Ability to Care for Patients

The novel influenza A (H1N1) virus could overwhelm the nation's health care system by exacerbating the existing shortages of physicians and other health care professionals, thus leaving some patients who contract the virus without proper medical attention. That was one of the main messages delivered by witnesses who testified before the House Committee on Small Business here on Sept. 9.

The Small Business Committee convened the hearing to assess the challenges of the H1N1 virus and its potential impact on small businesses and health care providers. During the hearing, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., told committee members that "even before H1N1 becomes a pandemic emergency, family physician practices will pay the price for our nation's shortage of primary care physicians."

"As the number of infections increases, family physicians in small and solo practices will be overwhelmed by the number of patients, simply because there is nowhere else they can go," said King. "The practices, which usually serve rural and inner city populations, will not have all the resources to handle a growing number of infected patients."

King told the committee that family physicians are on the front line of diagnosis and treatment of H1N1 infection. "Patients who are beginning to experience H1N1 symptoms often will go to their personal physician," he said. "Frequently, it is the primary care physician who begins to see the pattern of infection."

When an outbreak occurs, primary care physicians will need to provide health care services to both infected patients and the "worried well" -- patients who are not sick, but who need to be reassured and educated, he said.

"You have to take into consideration that flu season is (family physicians') busiest season, so we will have more people who will come in and want to be seen," King said.

Nydia Velazquez, D-N.Y., chair of the Small Business Committee, said during her opening remarks that, "Small health care providers have always been the core of our medical system -- 80 percent of doctor visits take place in small practices."

"These providers will be vital in distributing vaccinations and treating Americans who fall sick," said Velazquez.

During the question-and-answer period, Velazquez asked Anne Schuchat, M.D., director of the National Center for Immunization and Respiratory Diseases at the CDC and assistant surgeon general for the U.S. Public Health Service, about the federal government's plans to strengthen the capacity of the physician community to provide services.

"The scarce resources, in terms of providers, is a huge problem in many of our communities," said Schuchat. "For a pandemic, we really can't expect to have enough access everywhere. With a hurricane, for instance, we can send people from one part of the country to another part of the country, but with a pandemic, everyone may be affected."

Nevertheless, the federal government is "taking steps to try and broaden the provider community," including by tapping into the Medical Reserve Corps, said Schuchat. She acknowledged, however, that the pandemic "has not come at a good time in terms of our health care system's capacity."

Rebecca Blank, undersecretary of economic affairs for the U.S. Department of Commerce, focused on the economic impact of novel H1N1 influenza. "It is predicted that the arrival of the H1N1 virus, in conjunction with the regular season flu, will bring more illness," Blank said. Businesses, in turn, will be "confronted with greater absenteeism as employees or their family members are ill, thus reducing productivity."

"In a more severe outbreak, concern about the flu can lead people to avoid public places," Blank said. "This can reduce consumer spending and mean that some industries, such as travel and tourism, retail sales and service-oriented businesses, will experience a greater economic hit than others."

King, meanwhile, speculated on the potential impact of H1N1 infection on family physician practices from a business perspective.

"We are small businesses," he stressed during the question-and-answer period. The majority of family physician practices consist of just a few physicians and a small clinical and administrative staff.

"When staff members begin to show H1N1 symptoms, it is vital they stay away from the practice's office so that patients do not become ill," he said. "As a result, if an influenza outbreak infects just a few members of the practice, that practice may have to close temporarily."

King also pointed out that H1N1 vaccine will not be available until early October, and, in many instances, it can take 10 days to build up immunity to the virus after receiving the vaccination. As a result, physicians and other health care workers may not have sufficient protection against the virus until mid-October and may contract the virus before then, leading to a shortage of health care professionals to care for the ill.