Fewer family doctors accept Medicare

Rosemary Shinohara

The shortage of primary care doctors who will accept Medicare -- federal insurance for elderly and some disabled people -- is getting worse, says a new report from the University of Alaska Anchorage.

And as baby boomers hit 65 in the next 10 years, it could get harder and harder for the elderly population in Anchorage to find basic health care, says the report, produced by the UAA Institute for Social and Economic Research.

The problem is most severe in Anchorage, but also has affected elderly people in the Mat-Su Borough and Fairbanks, says ISER.

The statistics:

• About a third of 75 Anchorage primary care doctors surveyed don't accept Medicare patients now, vs. a fourth of 75 doctors interviewed in a similar ISER survey published about a year ago.

• Only 13 primary care doctors, or 17 percent of those surveyed, said they accept new Medicare patients. Only five of those doctors are in regular private practices. The others are in urgent care clinics, or at the Anchorage Neighborhood Health Center, a community health center that accepts all clients.

That's the same number of doctors who accepted new Medicare patients in the last survey.

• An estimated 47 percent of primary care doctors see established patients who are on Medicare.

The report offered some clues as to how Medicare recipients without private primary care doctors are coping: Many are going to the community health center, a hospital emergency room or to nurse practitioners.

The number of elderly Medicare patients seen at Anchorage Neighborhood Health Center has nearly tripled since 2003, from 546 to 1,453.

And the number of visits by Medicare clients to Providence Alaska Medical Center's emergency room increased at an annual rate of 12 percent from mid-2008 to September 2009, the study says. From 2004 to mid-2008, the annual growth rate was 2.5 percent.

The report estimates 10 percent of Anchorage's older people see nurse practitioners, who have their own practices and do many of the same things doctors do, such as prescribe medicine.

The ISER study, written by Rosyland Frazier, Mark Foster and Linda Leask, outlined some ways to help older Alaskans get basic health care, including increasing the capacity of the neighborhood health center. The center is raising money for a new, bigger facility, and got a $6 million contribution from the state in this year's budget. It expects to begin construction next spring.

Other alternatives: a Medicare clinic, such as one proposed by a group of Anchorage doctors; offering financial incentives to providers who take Medicare patients; and increasing the supply of providers.

Foster, one of the report's authors, said that when they wrote the report they didn't know about a plan by Providence Alaska Medical Center to start a clinic just for senior citizens.

After hearing about it, Foster said Thursday, "I think it's great. We have lots of options people are vigorously pursuing. We're going to make some progress."

Even with expansion of the neighborhood health center, a new Medicare-only clinic and the Providence clinic for seniors, there's still likely to be a shortage of primary care doctors for Medicare clients in the future, Foster said.

"The problem may be bigger than all three of those things combined," Foster said.

The ISER report notes in 10 years, "there could be twice the number of older Alaskans as there are today."