Doctor recruitment, retention difficulties plague Wayne County
By Phyllis Moore
Published in News on August 14, 2017 8:53 AM
Access to health care and recruiting and retaining doctors are among the top issues in Wayne County, according to a report presented at last week's Board of Health meeting.
Celita Graham, health educator, updated the board on some of the emerging issues.
One of the Health Department's ongoing goals continues to be increasing access to health care while reducing disparities among the vulnerable population, she said.
"Another part of this is to recruit and retain more primary care physicians for this area," she said, explaining that over the five-year period from 2010-2015, the number of primary care physicians per 10,000 residents in the county had stayed the same.
"Even if we can just get one or two (doctors) within the next few years, it will definitely help alleviate some of the burdens we have.
"Some of the doctors now can't even take new patients because they're maxed out."
One advantage Wayne County has is its proximity to East Carolina University, whose medical school has worked to retain some of its graduates to this area.
Board member Ed Cromartie, a commissioner, asked about the local physician recruitment process and how far-reaching the effort may be.
"Already, almost 40 percent of the physicians in this county are international medical graduates," said Dr. Jim Stackhouse, medical director for the Health Department. "They're coming from reputable schools."
Cromartie said he has noticed of late that patients are having to wait longer to be seen by a doctor, suggesting several reasons for that.
"I expect that either there are more people that need doctors, the Affordable Care Act has given more people a card so they're able to go in and get preventive care, or there's a lack of doctors," he said.
Stackhouse fielded the question.
"The distribution of physicians is the real problem in this country," he said. "Most countries have a health care system based on 50 percent of their doctors being primary care. We're hard to push 20-some percent (in Wayne County) right now."
He said that not as many medical graduates are pursuing family practice programs or the traditional practice with their own office. Instead, he said, they become hospitalists, immediate care physicians or the like.
"Ninety percent of doctors coming out now are going to be employed," he said. "Where they're going to be employed depends upon who owns the business that they're working for and whether they can make a living and make a profit in that business and sustain it.
"That model doesn't work in Wayne County right now. Wayne Memorial Hospital supplements its physician practice significantly to provide the services that are there."
The board also approved a new policy for the Health Department, allowing for termination of services in extenuating circumstances.
Health director Davin Madden said the policy is one that is perhaps overdue and should have already been in place.
"We are not in the business of trying not to see people. We see people even if they have an inability to pay," he said.
The policy provides flexibility in some cases, he said.
"If we have a consistent no-show from a patient, where basically it becomes a burden to the Health Department as well as to the services, we have an ability to evaluate whether we want to terminate services to that patient," he said. "If we have a case where patients' visitation and mannerisms make it where the provider cannot render pertinent care, the level of care and the way the care is being received by the patient or client is not conducive to really helping that patient, then we can choose to terminate services."
The policy also covers any behavior that may be threatening to the client or the staff and is simple and straight-forward, Madden said.
"It's basically the three-strikes-you're-out process that we send them a letter noting the violations and letting them know of the termination of services," he said.
Action is taken based upon recommendation from the provider, with the final decision being made by Madden.
In the case of threatening or potentially violent behavior, however, he said the "three strikes" rule becomes null and void.
"We can simply terminate services with notification," he said. "This policy allows us to do that."