Quoted Text

Is there a doctor around?
In remote areas such as Adirondacks, primary-care physicians can be hard to come by
BY MICHAEL HILL The Associated Press

   PCHESTERTOWN patients with palpitating hearts, high blood pressure and bad kidneys traveled for miles though the Adirondack woodlands on a recent rainy morning to see Dr. John Rugge.
   It was busy, but it’s always busy for Rugge. After all, he’s a rare breed in these parts: a rural doctor.
   At 6 million acres, the Adirondack Park wilderness area is larger than some states, but has just dozens of primary care physicians. And the situation is getting worse. Health care administrators say they are having a tougher time than ever recruiting and retaining doctors — one hospital this year pleaded for new doctors through mass mailings.
   Rugge sees the Adirondacks as a cautionary tale of how the national doctor shortage can affect rural areas around the nation.
   “We’re at the brink of a true crisis and, medicine being medicine, that can’t be turned around in a day or a week or a year,” said Rugge, chief executive offi cer of the not-for-profit Hudson Headwaters Health Network.
   The federal government estimates the nation is short by thousands of doctors. As the United States has grown bigger — and older — the number of medical school graduates held fairly steady through 2005. Over the same period, a growing number of doctors have opted to pursue lucrative specialty practices, contributing to a shortage in primarycare physicians.
   The problem is particularly acute in rural areas, as doctors gravitate toward cities for more money, more culture or fewer on-call shifts at larger institutions.
ON-OFF SWITCH
   Remote areas such as the Adirondacks tend to operate on the knife’s edge, as there are so few practitioners to begin with; the loss or retirement of even a few doctors can create big problems, said professor Thomas Ricketts of the University of North Carolina at Chapel Hill’s School of Public Health.
   “There’s kind an on-off switch there between terror and happiness,” Ricketts said.
   The shortage is not isolated to primary-care doctors and includes the gamut of medical specialties from pediatricians to oncologists. The University at Albany’s Center for Health Workforce Studies reported that there is one doctor for roughly every 535 residents in the counties that make up the bulk of the Adirondacks, compared with one doctor for every 311 people in the state as a whole.
   Headwaters has been looking since the spring for four primary-care physicians to help staff a network of 12 health centers across a rural swath of northern New York that includes the eastern Adirondacks. To the west, the Saranac Lake-based Adirondack Medical Center is looking for eight doctors, including two family doctors, to help staff its network of five centers in some of the least populated sections of the park.
   The hospital hired a recruiter who has met with medical students from New York City to Burlington, Vt., to promote the charms of the Adirondacks. They have mailed out 1,600 postcards to family practitioners around the Northeast to advertise two Tupper Lake jobs and about 1,000 more for an orthopedic surgeon opening.
   A particular concern is the hospital’s health care center in isolated Tupper Lake, which lost both of its doctors this year.
HARD TO COMPETE
   Chandler Ralph, Adirondack Medical Center’s chief executive officer, said the need for doctors will only become more pronounced as the area’s already older-than-average population ages.
   “If we can’t get primary-care physicians with the baby boomer generation coming forward, we’re going to be in trouble,” she said.
   It’s tough to compete with cities and suburbs for doctors. Rugge said his medical staff logged 314,000 miles last year shuttling between health centers — a distance equal to 128 trips between New York City and Los Angeles.
   Pay seems to be a big issue. Stories about doctors leaving the Adirondacks for more money elsewhere are common. Rugge said recruiting and retention is always difficult for Headwaters, but it’s worse than it has ever been since he helped form the network in 1974.
   Rugge and Ralph say lower insurance reimbursement rates in their area mean they can’t compete against city salaries. This is unfair because the cost of being a doctor in the Adirondacks is mostly the same, except for housing, Rugge said, noting that Headwaters had been losing money whenever patients with private insurance walked in the door.
   He recently negotiated higher rates to cover costs with four insurers that handle more than half of Headwater’s commercial business.
   Rugge said Headwaters receives adequate Medicaid and Medicare reimbursements, in part because the area they serve is federally designated as medically underserved. Not so for Adirondack Medical Center, where Ralph said Medicare covers less than three-quarters of doctors’ expenses and Medicaid covers about a third.
   “We cannot see the Medicaid population when we’re only being paid 33 cents on the dollar,” said Ralph, who wants the government to designate her corner of the Adirondacks underserved as well.
COULD GET WORSE
   As Rugge and Ralph look for more doctors, at least more finally appear to be in the pipeline.
   The Association of American Medical Colleges reported a record number of students entering medical schools this fall, though they won’t be able to compete for that crop of new doctors for another seven years or so.
   Experts still say the nationwide shortage is likely to get worse in the coming years.
   “It happens first and hard in the Adirondacks,” Rugge said, “but that doesn’t mean it’s not the case elsewhere.”


MIKE GROLL/THE ASSOCIATED PRESS Dr. John Rugge talks to patient Marie Girard at Hudson Headwaters Health Network in Chestertown.