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Specialist shortage has doctors worried Mail Tribune / Jim Craven Dr. Walter Emori examines Mary McCulley of Brookings, who drives three hours ever other month to Emori�s Medford office for a checkup for her arthritis. Emori and other Jackson County physicians are concerned that patients like McCulley could eventually have even fewer options if new doctors cannot be lured to the area. To see some physicians in valley, patients must wait months By Bill Kettler Mary McCulley drives three hours to see a doctor who can treat her arthritis. The Brookings woman travels to Medford once every two months to see Dr. Walter Emori. Other patients come from Klamath Falls and Lakeview to take advantage of his clinic�s sophisticated bone-density scanner and powerful new drugs that soothe their pain. "I feel very fortunate to have him," says McCulley, 77. "He takes good care of me." Emori, who turned 60 this year, wonders who will take good care of her when he gets ready to retire. Despite his clinic�s modern equipment and a thriving practice, Emori and his colleagues can�t lure a young rheumatologist to Medford. "This is wonderful new technology," he says, showing a visitor machines that analyze patients� bone strength. "And we can�t get anybody to come in and take it over. "Ordinarily you could just go out and get another rheumatologist and get him started," he says, "but there are no rheumatologists to get." Other Jackson County doctors share his concerns. Rogue Valley surgeons have been unable to replace colleagues who left Southern Oregon. Orthopedists have been searching for physicians to fill gaps that open as colleagues retired. Pulmonologists can�t recruit new doctors to share their heavy work load. Gastroenterologists, infectious-disease specialists, and internal medicine specialists would like to bring in reinforcements, too. Two things happen when there aren�t enough doctors to go around, says Jim Kronenberg of the Oregon Medical Association. "People have to wait to see a specialist. And when physicians work under constant strain, seeing more and more patients, some say, �To hell with it � I�m going to quit.� Then instead of five overworked physicians where you ought to have 10, you have none." Signs of the specialist shortage have surfaced across Jackson County. New patients have to wait months to see a specialist � if they can find one who will take them. Doctors in the most beleaguered specialties are spending more and more time on the job. Physicians cite several reasons for the shortage. Southern Oregon�s population has grown faster than the supply of physicians. The region�s popularity among retirees makes for disproportionately large numbers of people who spend more time in doctors� offices. And as work weeks grow, doctor salaries here lag behind those in bigger cities. Ann Gagnon of Ashland had to schedule an appointment four month in advance to see a gastroenterologist for a nonemergency visit. "He apologized as soon as he came in to see me," she says. Busy physicians have long since abandoned the 40-hour week. Emori starts his day with patient visits at 8:30 a.m. and finishes around 8 p.m. reading reports and journals. He has to turn away about half of the patients that are referred to his clinic. "I don�t count hours anymore," he says. "I get to eat at home about four times a week." Dr. Dan Fennell, a pulmonologist, calls 60 hours on the job "a light week." His days usually begin at 6:30 a.m. with hospital rounds and visits to patients in intensive care. Office visits start at 9 a.m. and continue through the afternoon. Then there are patient records to complete, and trips back to the hospital to check on patients. "I usually get home sometime between 7 and 9," he says. "I could work more if I wanted to." Dr. John Brawner, a surgeon, also talks of routine 12-hour days. "People are working close to five days a week, and every fifth weekend you�re working the whole weekend. "It�s not the type of job you finish when you leave the office. There are always more things you could have done." Patients� expectations have increased, too, says Dr. Lee Murdoch, a pediatrician and vice president of Primecare, Jackson County�s independent physicians association. New developments in medicine allow physicians to do more for patients than they could do five or 10 years ago. "I think it�s fair to say medicine has become global," Murdoch says. "The standard of care you expect in Medford, Oregon, has gotten to be pretty much the same standard of care you would expect in Chicago, or New York or San Francisco." Southern Oregon can�t begin to match what doctors can earn in big metropolitan areas. On average, Oregon doctors earn about 10 percent less than the national average physician�s salary, and doctors who work in big cities generally earn more than their colleagues in Medford, Ashland and Central Point. A doctor who might earn $130,000 in Medford easily can earn up to twice as much someplace else, says OMA�s Kronenberg. A six-figure income might sound like enough money to most working people, but young doctors often have big bills to pay. "Debt is a big part of it," says Brawner, the surgeon. "Some people finish medical school with $250,000 in debt." "That�s like starting your career with a second mortgage on the line," says Chuck Wright, chief executive officer of Providence Medford Medical Center. Providence and Rogue Valley Medical Center are working with local physicians to recruit new specialists. Dr. Michael Stone, who recently relocated to Ashland, says moving to Southern Oregon will mean about a 40 percent pay cut. Stone and his wife, Leslie (also a physician), came here from Idaho so their children could spend time with grandparents who live in the Rogue Valley. "All the reasons you shouldn�t take a new position were here," he says. Doctors say one of the reasons they earn substantially less here is the low rate of Medicare reimbursement. The federal health insurance program pays a set fee for each service, but doctors say the fees fall far short of their costs for providing the service. "Some doctors are rejecting Medicare altogether," Stone says. "On one level, it�s really good to not deal with Medicare. Why do you do anything that causes you pain?" Medicare reimbursement fees originally were set by analyzing each region�s medical costs. Areas that had high costs, such as Miami, Fla., were paid far more for each service than Medford. In 1997, for example, Southern Oregon�s Medicare reimbursement stood at $3,917 per person, compared to $8,690 per person in Miami. Doctors say money comes out of their pockets when Medicare reimbursements fall short of their costs for providing service. "Medicare is reimbursing a doctor about two-thirds of what it costs him to keep his office open," says Murdoch, the pediatrician. The specialist shortage extends beyond Southern Oregon. Fennel says there are at least five pulmonary doctor vacancies in Oregon alone. He traces the shortage back to federal policy decisions in the 1980s about medical training, when managed care and health maintenance organizations seemed to be the wave of the future. "There was a big push for family practice doctors," he says, "and training for the specialties dried up. "Initially there was little effect," he says. "But more specialists are retiring, either because of the bureaucratic crap or watching their salaries fall. We needed more specialists, not fewer." Murdoch says some specialist training programs have begun to expand in response to the shortage, but new specialists won�t appear in appreciable numbers for at least five years. In the meantime, Emori and his colleagues scout new recruits at medical conferences and talk to old friends who might know someone willing to move. "There are 25 arthritis doctors in Oregon," he says, recalling the demographic spread within his specialty. "Half are in Portland. The two youngest are just under 40. All the rest are over 40. Unless we get some new blood in here in the next few years, we�re all going to retire and we won�t have anybody." Reach reporter Bill Kettler at 776-4492, or e-mail [email protected] Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2000 Mail Tribune, Inc.