As hundreds of thousands of Illinoisans become newly eligible for health insurance next year, their search for adequate medical services will be most difficult in pockets of the state where a shortage of primary care physicians could be made more acute by the federal health overhaul.
Illinois is slightly above average compared to other states in its overall supply of primary care doctors. The problem -- as in most states -- is that doctors aren't evenly distributed, leaving some areas relying on nurses and physician assistants to provide care. Doctors don't necessarily go where need is greatest. Instead, studies have shown, they cluster in affluent areas.
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Gov. Pat Quinn has requested a statewide strategy to address the need for more health professionals -- not just doctors, but nurses and other providers.
Illinois Department of Public Health Director LaMar Hasbrouck, a physician leading a workgroup studying the gaps, said solutions in Illinois may include delivering health care through real-time video hookups, a fast track to credentials for military veterans who gained medical experience at war, sharing nurses across state borders and "warming up to the idea" that nurses and physician assistants can do more to deliver primary care.
Licensed practitioners need to work "at the very top of their license and experience and professional competency, so we can get every ounce of care from them," Hasbrouck said at a meeting on implementing the health law in Illinois.
It could be an uphill battle.
The Illinois State Medical Society, which represents more than 11,000 doctors, successfully lobbied against legislative measures this year to give nurses with advanced degrees more authority to practice without a doctor's supervision and to allow trained dentists to give flu shots and other immunizations. The doctors argued that it's unsafe to push those boundaries.
Twenty-two counties in Illinois have primary care doctor shortages, according to state and federal health officials. Another 200 pockets of Illinois have shortages, both in urban and rural areas. It would take nearly 1,000 new primary care doctors, according to a government estimate, to bring all those areas up to a healthy supply.
The most severe shortage is in Gallatin County on the Kentucky border in the far southeastern part of the state. The county of 5,500 residents has no hospital, dentist or full-time doctor. Some residents pay $50 a year for an air ambulance service that can fly them to a hospital in emergencies. Women deliver their babies at hospitals an hour away.
The lack of primary care is both a fact of life and a detriment to health, said retired teacher and community volunteer Kappy Scates of Shawneetown, whose regular doctor is in a neighboring county 20 miles away. "People without insurance or a medical card put off going to the doctor. They try to take care of their kids first," she said, adding that increased coverage through the Affordable Care Act will help.
Other Illinois counties with severe shortfalls of primary care doctors are scattered throughout the state. Many are sparsely populated and losing residents, according to Census data.
In the south, along with Gallatin County, widespread primary care doctor shortages exist in Washington, Clay, Fayette, Clinton, Johnson and Hamilton counties. In central Illinois, the countywide doctor shortages are in Menard, Macoupin, De Witt, Marshall, Shelby, Douglas, Mason, Moultrie, Piatt, Brown and Woodford. In northern Illinois, the counties with shortages are Henderson, Mercer, Carroll and Ogle.
Federal officials determine areas with doctor shortages based on a complex formula that involves not only the population-to-primary care physician ratio, but percentage of people living in poverty, measures of infant health and distance to the nearest available source of care.
With nearly 10,600 primary care doctors caring for patients, Illinois ranks 22nd among states in its rate of doctors per 100,000 residents, according to a report from the Association of American Medical Colleges. That puts the state slightly above average for its supply of active primary care doctors.
Nationally, there were 79.4 primary care physicians active in patient care per 100,000 Americans in 2010. Illinois had 81.8.
Utah had the fewest doctors to go around with 59.4 per 100,000 residents. Vermont had the most with 111.5 active primary care doctors per 100,000 people.
Recommendations from a 2010 report on the physician workforce in Illinois were never implemented, said Dr. Russell Robertson, dean of the Chicago Medical School at Rosalind Franklin University of Medicine and Science in North Chicago. He still holds out hope for the new statewide strategy, which he will take part in creating.
But Robertson said there are forces -- such as the so-called "hidden curriculum" -- that make recruiting new primary care physicians difficult. During training, he said, student doctors study with physicians who are specialists and who unintentionally dissuade them from primary care.
"They say, `You're such a smart person. Why would you want to spend your time providing primary care?"' Robertson said. "It changes their perspective."