Palm Beach County faces health care crisis as family practices dwindle

By Patty Pensa
South Florida Sun-Sentinel

June 24, 2007

Dr. Jim Byrnes already has more patients than most family practices, yet every week his office is hounded by dozens more in desperate search of a doctor.

Six miles west of Byrnes' Delray Beach office, Dr. Robert Cohen is fast building a practice. The Pittsburgh transplant has attracted 2,000 patients in less than a year.

Both are experiencing the effects of a physician shortage on the brink of collapse. It has touched medical workers from neurosurgeon to nurse, but none so far-reaching as the family doctor, considered the cornerstone of health care. In Palm Beach County, the population continues to grow while the number of family doctors is expected to drop.

"It's a sad fact," said Cohen. "There's a tremendous demand for good-quality doctors."

If nothing changes, patients could be left without a primary care doctor. It's a grim scenario affecting Florida and much of the nation.

The high cost of malpractice insurance and low reimbursements for care are the one-two punch against doctors. But family doctors have specific challenges: Like most doctors, they run businesses with high overhead, but family doctors get paid less for visits compared with specialists. As a result, fewer new doctors are turning to family practice as the number of physicians nearing retirement increases.

"If you can't find them, you're stuck using emergency care or urgent care centers," Byrnes said, "and you're stuck overburdening the whole system."

Family doctors average 2,000-2,500 patients but Byrnes has more than 3,500. His office has to turn away almost everyone who calls.

Byrnes works about 80 hours a week: He starts his day at 6 a.m. with his patients at the hospital, sees patients in his office during the day and finishes with paperwork by 7:30 p.m. On the weekends, he visits patients in nursing homes.

Byrnes, who is 55, expects to retire in 10-15 years. Half of Palm Beach County doctors aged 45-54 plan to stop practicing, reduce their workload or change their practices in the next few years, according to the Palm Beach County Medical Society.

The problem is exacerbated by the high number of older doctors here — 40 percent of the work force compared with a quarter nationwide.

As the county's population grows, the county will need about 375 family doctors in four years, according to the medical society. But with retirements, less than 200 are expected to be practicing.

"This is not an issue the medical community can work on and solve alone," said Tenna Wiles, medical society executive director. "It must be a community-wide effort."

Such challenges are occurring at a national level. About 100,000 family physicians practice in the United States. In less than 15 years, about 140,000 will be needed.

The group launched its "Future of Medicine" project last week to involve business, community and nonprofit groups in addressing the shortage. Earlier this year, the medical society's physician census for the first time revealed how drastic shortages are in some specialties.

About 300 family doctors work in Palm Beach County, about 40 fewer than what is needed, the study said.

The shortage, though, could be worse than statistics show. The study did not account for the growing number of doctors who abandoned their traditional practice for "concierge medicine," charging patients about $1,500 annually for more personalized medical care. Their offices have a smaller patient load, Wiles said.

Family physicians are primary care doctors who treat patients of all ages. Pediatricians and internists, who treat only adults, are also primary care doctors. They are expected to reach shortage levels in Palm Beach County when doctors retire in about four years.

"It's extremely expensive to run a practice," Cohen said. "On the other side, you can build a practice quickly because there is such need."

Family doctors in Florida make, on average, $150,000. Surgeons earn about $165,000 and obstetricians/gynecologists bring home about $180,000, according to the U.S. Department of Labor.

"It's very difficult to make any money in primary care unless you're seeing lots of patients," said Dr. Mark Multach, of the University of Miami. "And then, you're not doing your job well."

About 60 percent of Cohen's income goes to overhead such as paying his staff and for equipment. Cohen, though, has augmented his practice to offer blood tests and bone-density scans. He's looking to buy a sonogram machine.

Adding services, which often come with higher reimbursements, can help supplement a doctor's income, Multach said. Insurance and Medicare reimbursements have fallen in the past decade, leading doctors to squeeze in more patients per hour.

A typical office visit will bring a doctor about $30-45. In comparison, reading a stress test nets hundreds of dollars and takes less time, Multach said.

Florida's shortages are most severe in central and northern counties, though virtually all of the state has some degree of a doctor shortage, according to HealthLandscape, which maps data from American Medical Association and the U.S. census.

At the same time, fewer medical students are turning to family practice. A decade ago, it was about 16 percent of students. Today, it's about half that, according to the American Academy of Family Physicians.

Meanwhile, the demand for family doctors is expected to rise as more Americans confront chronic conditions such as high blood pressure and diabetes.

"In 15 years, when we need them more, the primary care physician won't be here," Multach said. "I'm pretty confident of that. Certainly, the system could change. There's been a lot of talk but there's been no movement."

Patty Pensa can be reached at ppensa@sun-sentinel.com or 561-243-6609.