This article first appeared in the St. Louis Beacon, June 8, 2009 - Mounting job losses, increasing insurance costs and a reluctance to spend money in a recession are keeping people in St. Louis and elsewhere from going to the doctor. But it's not just the patients who are hurting; doctors are suffering, too.
Fifty-four percent of physicians have seen their patient numbers drop since January 2008, according to a survey released May 19 by the American Academy of Family Physicians. In particular, people are putting off non-emergency care such as pap smears, mammograms and colonoscopies. Fewer patients have resulted in pay cuts for many doctors.
PATIENTS SCHEDULING BUT NOT SHOWING UP
Colonoscopies are a staple of gastroenterologist Michelle Woodley's practice. Her office schedules roughly 20 patients a day, the same number the digestive system specialist has seen during each of her three years of solo practice at Missouri Baptist Hospital. What's changed is that a third of them don't keep their appointments -- and don't call to cancel.
"They're just not showing up for the office visit," Woodley says. "Either they can't come in because they can't afford their copay or they can't get off work because they're afraid they'll lose their job."
These no-shows cost her money since other patients could have taken those spots. And with copays and premiums skyrocketing, and deductibles doubling, even those who do come in have to make tough choices when the bill is due. "It's pay the doctor or pay for the groceries," Woodley says.
Outstanding balances, fewer patients and the growing costs of rent and insurance have resulted in Woodley's income being slashed in half during the past nine months. On top of that, the minuscule increases in Medicare payments and the rising cost of doing business mean it actually costs Woodley money to see Medicare patients.
Even so, if a regular patient needs treatment, it's often on the house.
"I can't count the number of patients to whom I've said, 'We're doing this for free; you need this done,' " Woodley says.
SALARIED DOCTORS FARE BETTER
So far, Woodley has managed to keep her office employees working full-time. But the support staff in pediatrician Ken Haller's group practice at Cardinal Glennon Children's Medical Center has seen its hours reduced because not as many patients are coming in.
Cuts in the St. Louis Metro system have exacerbated the problems of parents who already face joblessness and high premiums, copays and deductibles, making it even more difficult to take children to the doctor. Now, many children Haller (right) might have once treated in his office are ending up in the emergency room instead, after parents put off minor medical problems that turn into big ones.
While many of Haller's patients and colleagues are struggling, his own bottom line hasn't been affected -- not yet. Haller is paid a salary by Saint Louis University. His salary is not tied to how much money the practice brings in. But he's concerned that only certain doctors will make it in a continued recession.
"People who are working on a salary level, and see patients who have the ability to pay, are going to weather this," Haller says.
WHAT'S NEXT?
At a time when their patient loads and incomes are decreasing, doctors also face a daunting and expensive change in the way they do business: a push by the Obama administration to switch to electronic medical records within five years. Estimates for computerization range from $25,000 to $80,000, a big bill for any practice, but especially for a small office with no one to share the cost.
The president-elect of the St. Louis Metropolitan Medical Society, internist Sam Hawatmah applauds the idea of electronic records, but he's not sure how he and others will pay for that conversion -- even with promised government assistance.
He's concerned that many financially strapped colleagues will try to reel in their red ink by turning away Medicare patients.
The doctor shortage started to become acute in 2005 with population growth and an increasing number of aging citizens, according to a November 2008 report from the Association of American Medical Colleges.
"They are our senior citizens; someone's got to take care of them," Hawatmah says.
A big wave of physicians is scheduled to retire in the next few years, Hawatmah says, and he wonders who will replace them. With the cost of medical school plus living expenses running as high as $60,000 a year, Hawatmah fears good candidates will be unable to attend.
"I would advise my kid not to go to medical school," Hawatmah says. "He will have debt up to his eyeballs by the time he graduates, and he'll be in debt all his life."
Tuition at Washington University's medical school is $47,000 a year; it's $44,700 at Saint Louis University.
The frugal lifestyle of the Woodley family, which includes two teenagers, has helped them get by during the recession. Lacking a car, her son bikes to work. The family doesn't go to movies anymore.
But for Woodley, the 80 to 90 hours she works each week are worth it, even in the hardest of times. "It's the greatest job there is," she says. "I love it."
Nancy Larson is a freelance writer in St. Louis.
