Alaska's shrinking primary care pool reflects national crisis

A digest of this month's issue, including Alaska's shrinking primary care pool, the rising epidemic of prediabetes, and other issues of note.

It's a certain breed of physician that chooses to practice in the remote regions of Alaska, but those who do often find compelling reasons to stay. Keith M. Brownsberger, MACP, came to Alaska early in his career more than 40 years ago and stayed well past his required stint with the Indian Health Service. In a 2006 interview with ACP Internist, Dr. Brownsberger recalled the lure of the wilderness. He also remembered that the other practicing internists in Anchorage “pleaded with me to stay.”

The shortage of primary care physicians in Alaska has only gotten worse. As our story explains, many physicians have been forced to refuse new Medicare patients because of the gap between reimbursements and the cost of providing care, something that's happening to various degrees across the country. According to ACP data, 21% of internists who were board certified in the 1990s have left internal medicine, compared with only 5% of those who elected internal medicine subspecialties, and a despairingly low percentage of residents are choosing to enter primary care.

In response, ACP has lobbied Medicare to reform the flawed fee-for-service payment system in favor of the patient-centered medical home (PCMH) model of care. In a PCMH, the primary care physician coordinates care, acting as the point person in a network of providers. To find out more about the components of a PCMH practice, Members can download the PCMH Purchaser Guide at no cost.

The rising epidemic of diabetes is a glaring example of why it is so important to reimburse doctors fairly for effectively manage complex cases. As Stacey Butterfield's article reports, not only are diagnoses of full-fledged diabetes on the rise but an estimated 57 million Americans have symptoms of prediabetes, which experts say should be treated to the same cardiovascular goals as diabetes.

The easiest way for time-pressed physicians to respond is by pulling out their prescription pad, but experts agree that lifestyle modification should be the first line of defense. Working in concert with nutritionists, exercise physiologists and other members of a “diabetic team” focused on treating the whole patient is a good idea but one that is discouraged by the current reimbursement system. As endocrinologist Arvind R. Cavale, FACP, notes, “In real life, neither the patient nor the primary care physician has the time to sit down and do the things that are needed to make this a success.”

How are you dealing with diabetes, prediabetes, and other complex chronic diseases in the current reimbursement climate? Post your comments on our blog. We look forward to hearing from you.