Saturday, December 26, 2009

WYO med licenses up, full-time docs down

Here's the good news:

Wyoming granted a record number of medical licences in 2009...

And now, of course, the bad news

...but fewer newly licensed doctors are setting up full-time practices in the state, newly released figures show.

How can this be? Reporter Joshua Wolfson at the Casper Star-Trib explains it all for you

Of the 301 doctors who received licenses so far this year, only 18 percent reported working full-time in Wyoming, according to statistics from the state Board of Medicine. Industry experts say the figures reflect growth in telemedicine and the number of outside physicians who come to the state to fill gaps in coverage.

The fact that fewer new doctors are starting full-time practices in Wyoming concerns Dr. James Anderson, a Casper surgeon who serves as the board's president. A shortage of primary-care doctors creates the potential for error as patients are treated by different physicians each time they seek medical help.

"It increases the risk, having multiple people taking care of you, without some sort of electronic medical records to know what's going on," Anderson said.

The Wyoming Office of Rural Health release a report this year that showed 13 of the state's 23 counties had a shortage of primary-care doctors. It's shocking to hear that the majority of our counties don't have enough family doctors. Are these 13 counties the most rural?

The WORH June 2009 survey [] carries a few surprises. First of all, primary care physicians aren't just family practice and general practice docs. The WORH definition includes doctors practicing internal medicine, pediatrics and OB/GYN. It also includes non-physicians such as physician assistants, nurse practitioners and nurse midwives. So, even if a rural county has no docs, it might at least have a nurse-midwife around the deliver a bay or two.

Washakie County in the Big Horn Basin hasn't a single primary care practitioner for its 8,000-some residents. No OB/GYN docs for healthy baby checkups. No pediatricians for when Johnny pokes his eye with a stick. No nurse practitioner to find out whether you have the flu or just a bad cold. Washakie County includes Worland, home to the new Washakie Museum (grand opening summer 2010), a sugar beet processing plant (major client: Pepsi) and a great cafe, the Brass Plum on Big Horn Avenue (great sandwiches and homemade potato chips)

I guess that Worland patients have to travel north to Lovell in Big Horn County which has two primary care people. They could go south to Hot Springs County, which actually shows a surplus of docs. Must be those healing hot springs' waters that draw the docs. Rounding out the counties in the Basin is Park, home to Cody and its small medical center adjacent to the much larger Buffalo Bill Historical Center, and Powell and its community college. But Park County is also showing a shortage primary care medicos. Most Wyomingites know that residents of the Big Horn Basin make frequent trips to Billings with its two hospitals and many docs. Bozeman, too. Over the Big Horn Mountains is the V.A. in Sheridan. Casper and its hospital isn't far either. Ditto Riverton in Fremont County.

But preventive medicine is very difficult when you have no family docs in the vicinity.

Rural areas all over the West have similar problems. Well-educated docs and their families aren't particularly attuned to remote small towns and their lack of amenities. Some of those are frivolous (what, no double-shot caramel mochiattos?) to important -- education, arts, hospitals and recreation. Yes, some pediatricians and nurse practitioners may love slow-paced and family-friendly Worland. But others may not like the fact they must drive 100 miles for shopping and surgery and symphony performances. Why not live in Billings if you go there every weekend?

I am not a small-town person. In my adult life, Cheyenne (pop. 55,000) is the smallest place in which I wish to dwell. Laramie County is the most populous in the state and it boasts the most primary care practitioners at 56 and that's not counting the specialists who fixed my knee and psychiatrists who regularly inspect my head for cobwebs and spiders. If I can't get the right specialist here, I can always cruise down I-25 to Fort Collins or Loveland or Greeley or Denver. On Tuesday, our family will take a little trip to Fort Collins to see my wife's endocrinologist for diabetes care. It will take us 45 minutes door-to-door unless we get snow and then it may take an hour or we may not get there at all so we'll have to reschedule. Chris wishes that there was an endocrinologist she liked in Cheyenne -- but there is not. So she doc-shopped and found one.

We have a choice because we have insurance and proximity. Worland citizens don't have proximity. What happens when they're also uninsured?

In the CST article, Dr. Anderson outlines some obvious problems

As challenges to addressing the shortage, the report noted rural doctors typically work longer hours and have lower incomes than their urban counterparts. They generally also receive lower Medicare and Medicaid reimbursements rates.

Wyoming's laws concerning medical liability also serve as a disincentive to doctors, Anderson said.

"That's going to drop us down on the list, being one of the states with minimal tort reform, basically none," he said.

The number of doctors being licensed in Wyoming rose 26 percent this year over 2008. That's attributable to a streamlined licensing processes put in place by the state Legislature earlier this year, Anderson explained.

There are signs the increase in doctors seeking Wyoming licenses may continue into 2010. More than 100 physicians have pending applications with the medical board.

The increase is having a positive effect, said Kevin Bohnenblust, the board's executive director. Traditionally, Wyoming's small population has made it difficult to support medical specialists. The new figures show more specialist are practicing in the state, albeit on a temporary basis. The state still needs to recruit more doctors, Bohnenblust said.

"Things are moving a lot in the right direction because we are getting more physicians who want to be licensed to provide care to Wyoming people," he said.
"That's a great thing. The trick is, we can't let up."

So, specialists are practicing here but living elsewhere. That's great when you're a local doc seeking a consultation with a neurosurgeon in L.A. or heart specialist in Houston. Dr. Anderson even mentioned a doc in Australia who recently received a Wyoming license so he could read X-rays remotely. And who knows how many of those newly-licensed docs are doing the same thing in India or Indonesia?

I'm obviously not a physician. I'm just a poor schlub in Cheyenne who needs the occasional check-up or operation. I'm going to have an easier time accessing healthcare than another 59-year-old who lives in Worland. There's something wrong with that. It's possible that technology and even the new healthcare reform bill may improve the situation. It's also possible that the current economic crisis that's hit the cities of the coasts may cause some docs to reconsider life in bucolic Wyoming. The "local" trend -- local eating, local working, local artmaking --may also boost the number of small-town healthcare providers.

Meanwhile, residents of Sweetwater, Carbon, Washakie, Big Horn, Park, Uinta, Albany, Converse, Lincoln, Weston, Crook, Niobrara and Platte counties will keep on logging those miles on visits to the family doc, many of them located across the Wyoming border in Billings, Rapid City, Fort Collins, Salt Lake City and Idaho Falls. That's not only tragic for efficient healthcare. It also costs Wyoming's economy. On Tuesday, we're going to Chris's specialist in Fort Collins and eating lunch out and Chris is having her Saturn serviced and my daughter Annie is spending her Christmas cash in Old Town. I may visit my favorite place in Old Town, Ben & Jerry's, for an infusion of Chunky Monkey.

Economic development for Colorado but not for Wyoming.

CST reporter Joshua Wolfson has a blog at


Anonymous said...

I am a family doctor in WA state. I have worked in rural America, although I no longer do. It's not the amenities, it's not the isolation, it's not the malpractice insurance rates or the schools. It's the money. The problem with doctoring in rural America is that it does not pay. True, the hours are long in rural areas, but if the pay were right, you'd have the docs. It's the money, plain and simple. Your only chance of getting enough docs is to pay much much more than you do now, even more than docs get paid in suburban or urban areas. If you don't do this, you'll have a shortage until Kingdom Come.

Michael Shay said...

Good point, Doc. Tell me how that can happen. Pay rates in rural America (especially the rural West) are low. The feds subsidize rural airline services, agriculture, ranching and so many other services. Why not family docs?