Medical Emergency

An oncoming nationwide health care crisis is being felt in rural areas like Whidbey Island first, where the hospital district is having a tough time recruiting and retaining new doctors.

If things don’t change soon, there may be no doctors left on the island willing or able to take care of the vulnerable communities of elderly and poor.

This was the message doctors, hospital administrators, health care workers and patients gave to an aide for Sen. Maria Cantwell.

Piper McGregor, Cantwell’s Northwest Washington director, stopped by Whidbey General Hospital Wednesday to discuss health care issues.

Three island doctors, Dr. Lee Roof, Dr. Benjamin Hu and Dr. Mark Cichowski, and Whidbey General Hospital Administrator Scott Rhine spoke passionately about the problems, particularly the declining and uneven reimbursements from Medicare.

The situation is getting bleak on Whidbey. Rhine said the hospital is currently in the process of — and having a tough time — recruiting an ear, nose and throat surgeon, two internal medicine specialists, one or two family practitioners, an obstetrician, a pediatrician and three diagnostic imaging specialists.

The problem is that doctors and other health care professionals make much less money while working many more hours in rural-ish areas like Whidbey Island.

The doctors said it’s not about greed. They said they have seen their colleagues leave the island because they simply couldn’t pay for their staff, overhead and medical school bills and make a decent living.

Dr. Hu, a Coupeville urologist, said he gets recruiting offers from clinics around the nation every week. He said on his desk he currently has an offer from a group of doctors in Denver, where he would make two and a half times what he’s making now. And because he’d be working with a number of doctors in Denver, he would be on call only occasionally, instead of all the time.

“There’s a lot of pressure on me to leave the community,” he said, adding that he’s been trying unsuccessfully to recruit another urologist for nine months. He currently sees an average of 25 patients a day.

“We’re losing talent. We’re going to experience a brain drain and once that happens, it’ll take a long time to get that back.”

The doctors said the only solution, if they wish to stay on the island, may be to refuse Medicare and Medicaid patients. Many doctors around the state are already doing this. Medicare is a federal health insurance program for people over 65 and some disabled people. Medicaid is a joint state and federally-funded program for low-income people.

Rhine said that for every $1 the hospital bills to Medicare, they receive between 55 to 58 cents. For every $1 they bill Medicaid, they only get 35 cents in reimbursements.

Physicians in Western Washington have it especially bad. While the federal government reimburses physicians in Washington $3,500 a year for an average Medicare patient, doctors in New York, for example, get an average $12,000 a year for providing the same care.

Hu said the federal government based the Medicare reimbursement on historical data that shows Western Washington provided health care more efficiently. It basically penalizes Washington doctors for being among the first in the nation to bring efficiencies to medical care.

Moreover, doctors in rural areas like Whidbey receive less reimbursement than those in urban areas. To Hu, this is backwards. He points out that doctors in denser populated areas share office space with colleagues, significantly reducing the cost of doing business for each physician.

He said he has to pay for his office rent, the salaries of his office manager and all the other employees all by himself.

In other words, a doctor in Miami, Flor., for example, makes more than three times more than Hu for each Medicare patient. Yet the suntanned Miami doctor in a clinic with colleagues is probably paying much less overhead, medical insurance and so on.

Rhine agrees. “Medicare and Medicaid are the largest payers of medical care,” he said, “but they’re not paying competitive or equal reimbursements.”

At the same time, physicians have had to hire more people to deal with the onerous paperwork from Medicare and Medicaid. In the mid-1990s, Rhine said one doctor needed three support people to help handle billing and administration. Now, doctors need an average of five support people.

On top of everything, the doctors said the federal government is way too aggressive in pursuing so-called Medicare “fraud.” They said it’s easy for overworked doctors to make innocent mistakes on very complex Medicare paperwork. Such mistakes rarely mean additional Medicare funding for doctors, but they said the government is quick to charge fraud and level giant-sized fines.

“It’s like a sword hanging over us...” Roof said. “Is it any wonder physicians are saying no to Medicare?”

The problem is getting worse. Medicaid reimbursements were reduced by 5.4 percent this year. The Bush administration has asked for an addition 17 percent reduction in the next three years.

If that happens, Hu said he simply won’t be able to afford to stay on Whidbey.

With the growing number of elderly people in the nation, physicians are finding the bulk of their patients are on Medicare.

“We’re doing charity work for the vast amount of cases,” Roof said, “and then trying to live off the crumbs of a few privately insured (patients).”

Yet Rhine and the doctors also had criticism for private insurance groups. Hu said Regence Blue Shield recently and unilaterally decided to cut doctor reimbursements by 5 percent. At the same time, the insurance company increased premiums by 25 percent.

“Insurance companies have all the freedom to raise fees,” Rhine said, “and there’s no trickle down to hospitals.“

Complicating things even more, there is a nationwide shortage of doctors, nurses, pharmacists and other health care workers. Fewer and fewer people are entering medical schools as many view doctoring as a thankless profession.

“I have a son who has a brilliant mind,” Roof said tearfully, “and I’ve told him not to go into medicine.”

Before scrambling off, McGregor told the small audience that Sen. Cantwell is very aware of the issues and is working at piecing away at the problems. Yet she agreed that there needs to be some large, “overarching” action to change the system.

McGregor urged everyone to write or call their legislators.

Paging a doctor, any doctor

Whidbey General Hospital is holding a public forum with a panel of physicians and other health care workers to discuss the state’s ailing health care system.

The forum, “Will your doctor by there for you?” is set for Tuesday, June 25, at 7 p.m. in Conference Room A of the hospital.

Call community relations at 678-7656, ext. 4005, to RSVP.

You can reach Jessie Stensland at or call 675-6611.

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