Originally posted by tofuballs:
I have sat back and watched my home state, more so the current Governor (Remember Katrina), ban AA practice in LA with language in her proclaimation directly from the AANA. I will certainly not sit back and allow someone to practice Pain Medicine, a recognized medical subspecialty without proper medical training just because the Nursing Board of LA says it is so. What is next? Will the Nursing Board let surgical first assistant nurses start clipping aneurysms in rural Louisiana Parishes becuase there isn't a neurosurgeon within a 20 mile radius?
Also, if someone uses the argument that there aren't enough Pain Doc's in rural LA and therefore require physician extenders... that is absolute garbage! You will never attract subspecialty providers to underserved areas by changing practice laws to allow physician extenders to compete against physicians. You probably will be able to attract them to visit as expert witnesses.[/QUOTE]Have a friend at LSUHSC that sent me this article you may be interested in.
Doctor shortage widens
Primary care physicians becoming more scarce
Marsha Sills
[email protected]
The displacement of medical training programs after Hurricane Katrina could change the way the state trains doctors and possibly where those physicians decide to practice.
Even before the hurricanes, the state faced a predicament. Nearly 86 percent of its parishes faced a shortage of primary care doctors. These doctors deliver babies, treat flu symptoms, prescribe antibiotics for your child - the basics of health care.
An aging cadre of primary care doctors, a declining number of medical school graduates who pursue primary care and the unmet needs of rural areas mean the state needs to get more creative in attracting doctors to care for those living outside the state's major cities.
About 80 percent of doctors choose to practice within a 100-mile radius of where they finish their medical training. So, it's imperative that the state continue to offer residency programs outside of New Orleans, said Dr. James Falterman Jr., medical director of University Medical Center, one of the state's medical training hospitals.
"The value of having these people train here is self-evident," Falterman said.
A Price Waterhouse Coopers report commissioned by the Louisiana Recovery Authority on "Louisiana Healthcare Delivery and Financing System" suggested that the state disperse its primary care programs across the state to community hospitals. Too many programs are focused in New Orleans, the report said. However, the report suggests that specialty programs be based in Shreveport, Baton Rouge and New Orleans.
Both of University Medical Center's primary care residency programs - family medicine and internal medicine - are at capacity, Falterman said. The hospital also has picked up several programs that moved from New Orleans after Katrina, including the geriatric medicine fellowship program. UMC has applied for accreditation to start its own geriatric medicine program to respond to a shortage, said Dr. Lainie Moncada, associate director of the fellowship program. In July, Moncada will become the program's director.
"There is a growing number of geriatric patients," Moncada said. "We're trying to help meet that need, and the need is growing all the time."
Building a work force
Building a work force of physicians for the state's future is more important after the hurricanes. Training hospitals in New Orleans closed, said Dr. Rick Streiffer, who heads the family and community medicine program at Tulane University School of Medicine.
The state needs to start grooming its future doctors as early as junior high school and look at its admission policies to help recruit more interested students, Streiffer said.
"In rural areas," Streiffer said, "that's a challenge because those students usually don't have an environment that exposes them to those careers and doesn't make them competitive candidates. ... It's not that they're dumb or won't make good physicians, but their standardized test scores don't look as good."
Lafayette isn't one of the parishes considered to have a primary care shortage. But Iberia, St. Martin, Acadia, Vermilion and St. Mary parishes are designated as in high need of primary care doctors.
Accountability measures also need to be considered to make an impact on the work force, Streiffer said.
"I will have to say that our state schools have not been held accountable to produce the physicians that the state needs in specialties, and somehow people in the Legislature have to hold them accountable," Streiffer said.
Homegrown doctors
Six of the internal medicine residents who will finish the program this summer will stay in Acadiana, said Dr. Leela Lakshmiprasad, the residency program's director.
Dr. Kerry Schexnaider of Abbeville is one of the six who will practice in Acadiana, working in his home parish of Vermilion. Schexnaider had planned to become an emergency room physician and travel as a doctor on cruise ships. But that plan was changed after he began his internal medicine rotations. The patient interaction and making an impact at home appealed to him more.
"There's a big need in my hometown in Vermilion Parish," Schexnaider said.
A few years ago, the medical schools in New Orleans and Lafayette offered to pay for the third and fourth year of a doctors' training at UMC-Lafayette in the primary care programs. Other incentive programs that pay school loans and even offer visa waivers to international doctors have made some impact in staffing rural needs.
Dr. Nancy Briley Walker plans to return to her hometown of Crowley to practice family medicine. Walker has another year to finish her residency at UMC's Family Medicine Clinic. Before she began her residency in family medicine, Walker was set to specialize in pathology.
"I like that you get to see the outcome of things," Walker said. "It's very rewarding."
While the state is considering reform recommendations, it may not be as easy to convince students to choose primary care fields or to move to rural areas.
Quality of life
In a way, money and workload play a role in why some medical residents opt to specialize in a field, said Dr. Arshad Asghar, a nephrology fellow now at UMC after Katrina moved him and his wife, Dr. Saira Jamal, a geriatric fellow, out of New Orleans.
"The main reason why most specialize is you have to see at least 40 patients a day as a primary care physician and make less money. As a specialist, you still may see 40, but you make more money," Asghar said. "It's the poor design of the Medicare code."
Asghar was working as a hospitalist in Indiana before he and his wife made the move to continue their studies in New Orleans. His longtime interest in kidney disease led him to specialize, he said.
But Asghar and his wife have no intention of staying in Lafayette. If they stay in Louisiana, they'd rather live in a bigger city, either Baton Rouge or, possibly, New Orleans.
As with any profession, quality-of-life issues affect a doctor's decision about where he decides to practice.
Dr. Carlos Mendez is the co-chief resident in the internal medicine program at UMC. He's from Miami, but moving back to a larger metro area doesn't entice him after living in a mid-sized city like Lafayette. He wants to stay here with his family because of the school system.
"I had planned to return home, but once I started here, I like the quality of life and that a smaller city gives you the chance to get to know patients. You get to bond with them more," Mendez said.
Demanding hours
Dr. Max LaMarche has been a part of LSU's medical school faculty for about 30 years and has witnessed the waning interest in primary care among new doctors. He's chief of internal medicine at UMC.
With each group of residents, he anticipates that at least half will choose to specialize rather than practice primary care.
"To be a primary care physician means working 12 to 14 hours a day to be considered a good physician and to be successful," LaMarche said. "It's demanding. You have to have that devotion. You can't make someone go into primary care. You are a servant of the patient."
"You have a surgeon who does a surgery in 45 minutes - $1,500. An internist or family care physician isn't going to make that in 45 minutes," LaMarche said.
The Katrina factor
The shortage of primary care professionals extends beyond physicians.
"We're short of practically everything - specialists, nurses, dentists, allied health professionals," said Dr. Perry Rigby, current chair of the state's Medical Education Commission and acting director of the LSU School of Medicine's hematology fellowship program.
"While primary care is primarily emphasized, it's not the only thing that is short and in some cases, it may be the least short, but that's more variable now by geography in Louisiana because of the shifts that took place with Katrina," Rigby said.
Katrina has affected any progress the state may have made in recruiting and retaining medical school graduates in the state. Students were dispersed throughout the state to continue their training, and some students found placements out of state.
How quickly more beds open at the teaching hospitals in New Orleans will be a major factor in retaining graduates, Rigby said.
Originally published May 14, 2006
