Count of primary-care docs shows disparities

Larimer County has an excess of primary-care physicians and Weld County needs more in order to meet a state benchmark which says there should be one primary-care doctor for every 1,900 patients.

Under the Patient Protection and Affordable Care Act, many more people will be receiving health care, and state policymakers have begun examining whether enough doctors will be available to provide the care.

A new study by the Colorado Health Institute, a Denver-based nonprofit dedicated to health-care research, shows that Larimer County is home to 185 full-time primary-care physicians. Based on an estimated county population of 316,031 in 2013, that means there is one primary-care physician for every 1,709 people.

In Weld County, 107 primary-care docs serve a population of 268,639, or one for every 2,511 residents.

Colorado as a whole has 1,873 residents for each primary-care physician, slightly below the benchmark set by the health institute.

“There is no magic number that defines what is an adequate number of providers,´ said Gretchen Hammer, executive director for the Colorado Coalition for the Medically Underserved.
“It really varies across the primary-care spectrum.”

Primary-care doctors are defined as those who practice family, internal, general or pediatric medicine, as opposed to doctors who practice a specialty medicine such as obstetrics or cardiology.

But within the category of primary care, the need for doctors fluctuates by the type of medicine practiced, as well as the demographics of the area. For example, an area with more retirees will require more doctors that practice geriatric medicine while an area with young families will need more pediatricians.

While the exact benchmark may be a moving target, the medical community in Colorado is engaged in an “active conversation” about the number of these types of doctors and how to ensure there are enough of them in the future, Hammer said.

Students leaving medical school have a greater incentive to choose a specialty because salaries are more lucrative, according to Cari Frank, director of communications for the Denver-based Center for Improving Value in Health Care.

Data show that Northern Colorado has substantially more specialists than generalists. According to the Colorado All Payer Claims Database, in 2012 there were 22.6 doctors – of all types – for every 1,000 people in Larimer and Weld counties combined, but only 6.4 of those were primary-care doctors, meaning 16.2 were specialists.

Maintaining an adequate number of primary-care doctors in a community is important because they care for everyday health needs, Hammer said. Patients need to have someone they can see for treating a sore throat or ear infection without having to visit the emergency room or urgent care. Care at facilities such as these can be three or four times more expensive than receiving treatment from a primary-care doctor, Frank said.

When a patient receives care that is more expensive than it needs to be, it ultimately drives up overall health costs, which continue to climb every year nationwide.

Primary-care physicians also help patients coordinate preventive care, including administering immunizations or conducting annual physical examinations, but when a patient has a serious condition, these physicians also serve as coordinators between the army of specialists that are needed to treat the patient, Hammer said.

Another important concept to consider when thinking about access to care, Hammer said, is what’s called a “usual source.” This is a measurement that reflects how many people in an area feel they have a reliable source of care. In Northern Colorado, about 84 percent of people agreed that they have a usual source of care, according to the Colorado Health Institute, compared with about 76 percent statewide.

That provider is not necessarily a primary-care physician, and in the case of people on Medicaid, there is an increased chance that the go-to place for health care is an emergency room. Data from the Colorado All Payer Claims Database show that people in Northern Colorado who are on Medicaid are about twice as likely to visit an emergency room as the total population.

Because Medicaid enrollees often have less access to preventive health care and such things as immunizations, they often need more health-care services, according to the Colorado Health Institute, which has determined that one generalist is required for every 1,500 Medicaid patients.

Both Larimer and Weld counties meet this threshold, according to Colorado Health Institute data. In Larimer County there are 939 Medicaid enrollees for every PCP, giving it the second-lowest ratio in the state, and in Weld, there are 1,538 Medicaid patients for every primary-care doctor.

The expansion of Medicaid in Colorado, authorized and funded by the federal government as a result of the Affordable Care Act, could change that, according to Frank.

Beginning Jan. 1, the act authorized new coverage levels, allowing Coloradans earning up to 133 percent of the federal poverty level to enroll in Medicaid. As of Feb. 6, the most recent data available, 117,607 new enrollees had signed up statewide.

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Molly Armbrister covers real estate, banking and health care for the Northern Colorado Business Report. She can be reached at 970-232-3139, marmbrister@ncbr.com or twitter.com/MArmbristerNCBR
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