GOSHEN — A short message on the voice answering service at Maple City Health Care Center says it all.
“At this time, we are not accepting new patients. Thank you.”
The message isn’t new.
In fact, it’s been there for many years, according to the clinic’s medical director Dr. James Gingerich.
“At this point, we clearly have a shortage of primary care providers,” Gingerich said. “We recognize that, the hospitals recognize that. I think that’s something that everybody recognizes.”
And the shortage has reached the point where people, even those with insurance, come into the community and have a very difficult time finding a provider.
Gingerich said IU Health Goshen recently conducted a study that found about 10,000 people in the area do not have access to a medical home.
“There’s a primary care provider shortage nationally and regionally and in our local community,” said Larry Allen, chief medical officer at IU Health Goshen Hospital. “We’ve seen that personally as we look at how our providers here are almost all at capacity and not taking new patients.”
That affects even the youngest Goshen residents.
“Imagine having a new baby and nowhere to take that baby in the community for care,” Gingerich said.
To help, this summer Gingerich and his staff will begin accepting any baby born at the Goshen hospital with a Goshen address — and their family members.
“Our goal is to take about 5,000 new patients in the next couple years,” Gingerich said.
That’s making a dent, but it’s not addressing everything, he added.
Provider shortage
Elkhart County isn’t alone in the struggle to find enough physicians to serve patients currently on the waiting list.
According to the Association of American Medical Colleges, the United States will have a primary care physician shortage of 91,500 by 2020 and 130,600 by 2025.
The same is true for many Hoosiers.
Indiana ranks 39th in the country in terms of the number of physicians to population, according to an August 2012 study by the Indiana Center for Health Workforce Studies, the Bowen Research Center at the Indiana University School of Medicine.
The report found that only 11 out of 92 counties in the state meet the standard of 100 primary care doctors for every 10,000 people. That standard was set by the Robert Graham Center.
The list of 11 counties includes Elkhart, St. Joseph, Allen, Hamilton, Hendricks, Lake, Madison, Marion, Porter, Vanderburgh and Vigo counties.
Population-to-provider count per 100,000 people for local counties according to 2010 census data. Primary care providers include physicians, physician assistants and nurse practitioners:
• Elkhart County — 124
• Kosciusko County — 30
• LaGrange County — 18
• Noble County — 19
• Marshall County — 33
• St. Joseph County — 213
Changing health care system
A recent study conducted within Beacon Health Systems — the nonprofit parent organization of Elkhart General Hospital — found that in 2016, there will be a surplus of 17.8 family practitioners, said Dr. Vincent Henderson, the medical director for Beacon Medical Group.
“And while that may sound like a great thing,” he said, “we have to delve deeper than that.”
A shortage of 15 internal medicine physicians, combined with a surplus of two obstetrics and gynecology doctors, plus a shortage of 14 to 15 pediatricians results in an overall shortage of providers for Elkhart County, Henderson explained.
Population growth, a growing number of physicians reaching the retirement age and a work-to-life balance sought by today’s providers are all contributing factors to the shortage, Henderson said.
“Years ago, many physicians worked 24/7 and well past the retirement age,” he said. “A lot of providers today are looking for a better work/life balance with more defined working hours.”
In addition, more than one-third of primary care doctors in rural counties are within a decade of retirement, according to the Indiana Center for Health Workforce Studies and the Bowen Research Center report.
Layer those changes on top of a new health care model and there’s bound to be a few challenges ahead, Henderson added.
“With the new HIP (Health Indiana Plan) 2.0 within the state of Indiana, we expect the demand to increase and we are trying to prepare for that increased demand,” Henderson said.
HIP 2.0 is a health insurance program that pays for medical expenses for uninsured, low-income adult Hoosiers ages 19 to 64, according to the Indiana Family and Social Services Administration. Hoosiers with incomes of up to $16,436.81 annually for an individual, $22,246.25 for a couple or $33,865.13 for a family of four are generally eligible to participate in the plan.
Specialists
While many area residents may struggle to find a primary care physician, finding a specialist can be equally challenging, local doctors said.
Specialists like rheumatologists to serve an aging population, neurology and end-of-life — or palliative — care providers all top the list for local needs.
Orthopaedics, gastroenterologist and cardiologists can also be difficult to come by, according to medical leaders at two area hospitals.
Depending how competitive the field is for a particular specialist, recruiting them to smaller towns like Goshen can be complicated, Allen said.
In addition to serving as IU Health Goshen’s chief medical officer, Allen is also a family physician in Syracuse.
“Many primary care and specialists do their residencies in cities and it takes a while, so by the time they’re finished with school, they’ve started a family and are more likely to stay in those areas,” Allen said. “We really need them to have a connection with family members or history here to get them to come.”
And once they’ve been recruited, losing a specialist can be exceptionally difficult.
“When you consider that a family doctor cares for 2,000 people — that’s pretty reasonable — and if we have 50 doctors and lose one, well, that’s a problem since we have a shortage anyway,” Allen said.
But whereas a primary care doctor’s patients can be distributed among other local doctors, it’s a larger challenge with specialists.
“They may take care of 20,000 people and if one leaves and we only have two doctors, that’s half our capacity,” Allen said. “That’s why it’s kind of spotty as far as what our problems are.”
Another of the challenges with attracting specialists to Elkhart County and the surrounding area is the limited number of physicians already here, Henderson explained.
“Most physicians when they look at trying to provide specialized services, they want to be in a group setting with other similarly situated specialists,” he said.
Without a second physician in the same office to cover appointments, scheduling even a week-long family vacation is a logistical nightmare.
Increasing access
Perhaps the biggest challenge is there’s no simple solution, Allen said.
“We’re trying several things,” he said. “We’re building a new clinic, having more of our doctors open on Saturday mornings and looking for ways to increase our access.”
In May, a second Maple City Health Care Center opened in the former Abshire Mansion in Goshen. IU Health Goshen purchased the mansion in late 2013 and is leasing it to Maple City Health.
Also in May, IU Health Goshen officials broke ground on what will become a 10,000-square-foot clinic space at 2824 Elkhart Road, Goshen. The new clinic, which officials say will expand primary and urgent care to 10,000 residents, is expected to open before the end of the year.
But for residents who can’t find a primary care doctor, retail clinics and urgent care can also help fill the void, he said.
“If someone hasn’t been sick before and they go to the emergency room and find out for the first time that they have diabetes, the best way to get those people healthy over the long term is to get them a primary care physician,” Allen said. “We can refer them to our physicians, but that’s only a one-time visit.”
Health officials throughout IU Health Goshen are looking at ways to incentivize physicians to come to the area and to connect residents with primary care physicians to keep them out of the emergency room, Allen added.
They’re also trying new things — like a team care model where patients are seen by one doctor and then connected with a second physician to serve their individual needs without having to travel outside the office.
“Part of it’s a connection problem,” Allen said. “We need to be connecting those people to the care they need and when our current practices are at capacity and not capable of taking more people, that’s difficult.”
Follow Julie on Twitter @jbeer_tgn
Find a doctor
• IU Health Goshen Hospital maintains an online directory of area physicians with information about whether doctors are currently accepting new patients. For more information: iuhealth.org/find-a-doctor/
• Beacon Health Systems also has an online directory available at beaconhealthsystem.org/medical-group/find-a-provider/
