FRANK: How to solve Carmel’s physician shortage

Stuffy nose and shaking chills? Need a doctor? Good luck finding one in Hamilton County. As an influenza epidemic races through Indiana and Obamacare demands that you select your primary care physician (PCP), many in suburban Indianapolis cannot find a health care provider.

Raised on the north side of Indianapolis, I’ve been a primary care doctor here for nearly 15 years. “Are you accepting new patients?” is a constant refrain in my world. I can hardly keep up with the practice I have, let alone accommodate the need as it exists.

There are about 40 PCPs in Carmel, a city of approximately 81,000. According to the U.S. Department of Health and Human Services, a population of 100,000 requires 60 to 80 primary care providers. Making matters worse, fewer than 10 of the 40 doctors in Carmel are accepting new patients.

The supply of new PCPs cannot meet demand. Who can blame a medical student who might have accumulated $250,000 of debt for selecting the solitude of a radiology reading room over primary care? According to the 2014 Physicians’ Compensation Survey, radiologists earn five times more than primary care physicians.

Primary care is a grueling job with unpredictable economics exacerbated by the ever-shifting legislative environment. While physician incomes are among the highest in the nation, paychecks come with quality-of-life sacrifices.

I’m accustomed to interrupted sleep and patients asking me at cocktail parties about their scary moles. I’ll research cost-effective options for patients, spending hours on hold with insurers obtaining authorizations. I’ve been verbally abused, physically threatened, stood up and financially stiffed.

The doctor-patient relationship is a moving target. Many physicians jump from one office to another, seeking the holy grail of practice environments. Furthermore, insurance networks are a revolving door; everyone knows that provider lists are outdated and inaccurate. Selecting your mandated PCP is a dizzying task, and finding their phone number is downright impossible.

Doctors also are dropping like flies. The first day of my career, a 40-year-old partner announced he was leaving the practice of medicine. Forever. Patients who’d been under his care for decades were adrift, left with a frustrating search for an experienced, compassionate and efficient physician.

With few entering the practice (and staying put) and so many calling it quits, it’s no wonder you’re out of luck with that sinus infection.

Urgent care centers meet the short-term demands of a “doctorless population.” Indiana law allows physician assistants and nurse practitioners (also known as mid-level providers) to assess patients and prescribe treatments.

Pharmacy chains have strategically placed these clinics at every major intersection—essentially convenience stores for health care.

Mid-level providers see patients without any direct physician oversight. Similar to a hot dog festering on rollers at the gas station, the treatment you receive is often inconsistent, mediocre or downright dangerous.

By contrast, a mid-level provider housed within a primary care practice collaborates directly with the doctor and is attuned to patients’ entire medical history. Physician practices across the country have added nurse practitioners and physician assistants in order to meet a growing primary care void.

Mid-level providers are poised to solve our nation’s primary care shortage. Despite this reality, educated adults often spurn the concept. This attitude, whether reactionary, ignorant or both, can’t last long. Doctors in Indianapolis and beyond (including me) can’t do this alone.

Hamilton County, listen up! You need a primary care home, and mid-level providers are waiting with open arms.•

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Frank is an internal medicine physician living in Carmel with her husband and three children. Send comments on this column to ibjedit@ibj.com.