There are varying opinions about the physician shortage in Illinois, and according to the Association of American Medical Colleges Illinois is slightly above the national average for availability of primary care physicians, but how does this shortage impact people in central Illinois?

THE ISSUE: Physician shortage in Illinois

HOW IT MIGHT AFFECT YOU: With fewer medical doctors available, Illinoisans are having to sometimes take alternate routes in their medical care - sometimes more costly, too. 

There are varying opinions about the physician shortage in Illinois, and according to the Association of American Medical Colleges Illinois is slightly above the national average for availability of primary care physicians, but how does this shortage impact people in central Illinois?

Three local doctors recently gave their thoughts on the topic.

University of Illinois College of Medicine at Peoria

Thomas B. Golemon, MD, Family and Community Medicine at the University of Illinois College of Medicine at Peoria, said there has been a physician shortage for about 10 to 15 years.

Golemon, 66, a family doctor, called primary care physicians, focusing on pediatrics, family medicine, and general internal medicine, a “dying breed.”

More residency graduates are going into specialty fields, Golemon said, for higher salaries and promises of help with payments toward medical school debt, which can be about $200,000.

“Instead of going in for three years and doing general, they go into specialty care because it pays a whole lot better,” he said. “Gastrologist, neurologist — those people no longer do the primary care job. Primary care to me is whoever walks in the door. They take care of whatever problem (the patient) has.”

While Golemon said he does not “begrudge” those who choose to become a specialist, he said he hopes the only driving factor is not pay.

Golemon said he appreciates the knowledge of specialists, but he said, “We pay for procedures more than we do thinking.”

“The way our current system is set it’s a fee for service. The more procedures I get to do the better I’m reimbursed. More people want to go to an outcome based payment system rather than how many widgets are produced that day,” he said. “The idea would be to look at the outcomes, how people do under your care. Do you actually sit them down, look them in the eye and talk to them ... as opposed to how many people you crowd through the office and get paid per head?”

Primary care physicians are not quite yet a thing of the past, but Golemon said there are fewer and fewer of them each year.

“Salaries are changing. Family care gets paid less. We need more family doctors,” he said.

Golemon’s wife, Joan, is also a doctor who works at the U of I College of Medicine. Golemon said his wife related that family doctors there are getting offers of $200,000 to $250,000 a year, while orthopedists are getting about $500,000.

Barbara Starfield, a pediatrician from Johns Hopkins, did research in the mid-80s to 2000, looking at the impact of primary care on nations versus specialty care docs.

“She found that the more primary care doctors there were the better the health of the nation in general,” Golemon said. “There’s something about the one to one relationship.”

The relationship between a doctor and a patient is an important one, Golemon said, with the doctor learning the patient’s history.

"If someone comes to me and I’m a family doctor and they have chest pains I may or may not send them to a cardiologist because it may not have to do with their heart. It’s harder for me to treat if I don’t know what your family life is like.”

Locally, if people can’t find a primary care physician, they go to the emergency room, Golemon said.

“That’s not what the ER doctors are trained to do. They are trained to take care of emergencies,” he said.

In Canada, Golemon said there are limits on the number of specialists allowed.

“Of course this is a much different system here .... if it’s drive by cost we may find we don’t have any primary care doctors.”

With health care being very costly and good health care not being accessible to subgroups, Golemon said he does not think Americans will put up with it forever.

“I keep going back to what Churchill said, ‘Americans always do the right thing but only after trying every other alternative.’”

OSF Healthcare

Les Mathers, MD, senior vice-president to OSF Healthcare, has been a physician for most of his life. He finished medical school in 1976. Over this time, he has seen a population that keeps growing and that keeps aging.

“Most people feel like we don’t have enough physicians in many fields,” he said. “Mainly most people think this is in primary care or family medicine. This is especially true in rural and big urban areas.”

The shortage issue, Mathers said, leads to people not having good coaching on health care and access to services.

“Sometimes people get the wrong care because there is not someone easily accessible,” Mathers said. “It’s been a long-term problem that’s gotten worse probably over my lifetime in particular.”

The current model of education and economics involving health care, Mathers said, “has sort of promoted people to go into education that is very narrow and specialized.”

“It’s great ... but we sort of missed the boat by not having people go into general medicine where they are helping people avoid problems and help maintain them.”

Today, there are more requirements for doctors and more work for them due to technology.

“Doctors spend a ton of time recording information electronically and working on computers while trying to see patients as well,” he said, adding that over the last several years doctors have less ability to see as many people.

When Mathers first got his start as a doctor he said he saw probably three times as many patients as doctors do today.

“When I first started practicing there were essentially no electronic records available. ... Even when you created one there was not the ability to tie it to a hospital. Most were handwritten and dictated and typed,” he said.

What are some solutions for the current issues doctors face?

“It’s probably more than one item. ... When they interview people going into medical school before they’ve even started ... the majority of these young students are not thinking about going into primary medicine or a primary care field ... they think it sounds cooler to be a specialist. They think they will have more control over their lifestyle and make more money.”

The average kid coming out of medical school today is $185,000 in debt, Mathers said.

“We see many people who have over $300,000 in debt, and if they are going into an area of practice that does not give them reimbursement it’s a real challenge for them to pay off debt.”

Medical areas with a specialization are being rewarded with a higher income, Mathers said.

“Those areas are very important. I’m not trying to take away from sub special fields,” Mathers said, however, he added that the “vast majority of things can be cared for by a primary care doctor and their team of care providers.

Because primary care doctors have to be more “well rounded” to take care of their patients, Mathers said they deserve more pay and he thinks there is a trend going that way.

Mathers likes to use an analogy to bring his point home.

“If you are wanting to build an apartment complex or real estate you’d want to have a good general contractor. You’d also want to have a good plumber,” he said. “We’ve tended to pay more to the sub contractor than the general contractor.”

Pay for primary care physicians can vary, depending on what community they are in, Mathers said. Most primary care physicians make in excess of $180,000, he said. However, even if a physician is attracted to Illinois for the pay, one thing that may keep a doctor from staying are the taxes.

“Illinois’ up there,” Mathers said. “The same with professional liability. Malpractice costs are higher in Illinois than in many other states.”

Over the past five to seven years, Mathers said the number of people going into family medicine has increased a bit, but has not kept up with the aging population.

“I think if we had really good teams of primary care providers then we could make the whole access to care more efficient for patients and more readily available for them and provide better continuity and lower their costs,” he said.

Pekin Hospital

Dr. Gordon Cross, medical staff president at Pekin Hospital, invited Todd Sagin, MD JD, to speak at the hospital last fall.

Sagin of the University of Pennsylvania provided some sobering statistics. He said that by 2020, there will be a physician shortage of 200,000. Currently, only 1 in 6 surgeons is now less than 40 years old.

“One-third of practicing physicians are now 55 or older, so 1 out of 3 won’t be practicing within next 10 years,” Cross said, and “42 percent are now over 50 and they won’t be working in 10-12 years.”

There are 40 million people on Medicare and there will be 80 million in 2030, so the production of physicians are not keeping up with demand, Cross said.

“The Affordability Care Act is trying to shrink residency programs,” he said, and we are “seeing massive growth of health care that are not primary care doctors providing health care.”

While Cross agrees with Golemon and Mathers that the number of physicians are not keeping up with the aging population, he has a different opinion about the career path medical students are taking.

Ten years ago, Cross said he would have agreed that medical students were not pursuing a career as a family practice doctor, but he doesn’t think that’s the case now.

Cross said more medical students are pursuing careers as a private doctor because they want to work from 9 to 5 and not be on call 24/7.

“They’re picking lifestyle over larger salaries,” he said. “They don’t want to be in school until they are 33.”

Because of the length of time one has to stay in school to be a specialist, Cross said he thinks those areas will actually be lacking in the future, especially surgeons.

It takes an average of two years to train a nurse practitioner.

“The people who are really sick, how does someone recognize that they really need the care of a physician? I think that’s asking a lot for someone who has two years of training.”

Those who go into family practice get out of school at the age of 28 or 29, while a radiologist is 32 years old. Neurosurgeons don’t get out of school until the age of 36.

Cross, a radiologist, finished his residency at the age of 30. For 12 years he was in training.

“I’ve got two teenagers and they look at me like I’m nuts. They say, ‘You think I’m going to go to school for 14 more years? I don’t think so,’” Cross said.

Because of the longer hours, Cross said he thinks medical students will steer away from specialized careers in the medical field. Cross said he has a friend who is a surgeon who works eight to 10 hours a day and then spends two hours on electronic records at home at night with no reimbursement.

“You can’t train someone to be a surgeon in two years. I don’t think I want someone cutting open my skull who has trained for two years,” he said.

It took Pekin Hospital five years before they found a surgeon, Cross said.

Within the past 10 years, hospitals have been hiring private practice doctors. This appeals to the doctors, Cross said, because they don’t have the overhead of a private office and it is more efficient. These doctors do not have a contract with the hospital and are not paid by the hospital, they just use the space there to offer their service.

There are 300 on the medical staff at Pekin Hospital, but there are 50 that go there often. Of those 50, Cross said 80 percent are actual hospital employees.

“I think that’s what’s happening in the country. I think what we see here in Pekin is going on nationally. A doctor that used to work 12 to 16 hours is now working eight hours,” Cross said.

Cross fits into this category. He does not have a contract with Pekin Hospital and can practice anywhere.

“We only make as much as we can earn. We have no guaranteed salaries at all. I’m not whining about that. That’s the difference,” he said.