Experts Say Reform Means Problems for Primary Care; More New Patients Is Likely to Lead to a Doctor Shortage

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Byline: JEREMY COX

The new federal health reform law expands coverage to 32 million Americans, including tens of thousands on the First Coast. Now, who will treat them?

Those in primary care - practicing it and teaching the next generation of front-line physicians - say they're not exactly sure. Although the wide-ranging law offers several measures aimed at retaining and creating primary doctors, there still might not be enough doctors to go around, particularly in poor and rural areas, they say.

"You're going to have all these people with some coverage to get their care, and yet where are they going to go?" asked Joe Crozier, executive director of the Northeast Florida Area Health Education Center. The agency runs a program that enables medical students and resident physicians to train in rural and underserved parts of the state.

The health reform law could force patients, mostly the new ones, to wait longer to see a primary-care doctor.

Before President Barack Obama signed the bill last month, the American Academy of Family Physicians was already predicting a shortage of nearly 40,000 family doctors nationwide by 2020. That almost certainly will grow because of the law, experts say.

In Florida, the existing need for primary care is even more dire than the nation as a whole, according to a federal analysis. About 15 percent of Florida residents live in areas where there is a shortage of primary-care professionals; nationally, about 12 percent live under such circumstances.

Areas federally designated as short on doctors in Northeast Florida include all of Baker and Nassau counties and low-income parts of western St. Johns County and the Northside of Jacksonville.

Although northern Clay County isn't on the list, it seems like it should be, said William Choisser, a family physician in Orange Park. Over the past year, four family doctors in Clay have stopped practicing in the area, leaving scores of patients looking for a new gatekeeper to their care, he said.

Choisser already works 50-hour weeks and would like to hire a second physician assistant to handle his office's growing workload. But he can't afford to pay one, he said.

Therein lies one of primary care's biggest pitfalls.

The average income for a family doctor is about $180,000 a year, less than half the pay of a dermatologist or a urologist, according to a 2009 survey by the Medical Group Management Association. For the many medical students who leave college with more than $100,000 in student loans, primary care is often not their first job choice. …