According to data in a recent report for SUNY New Paltz’s Center for Research, Regional Education and Outreach (CRREO), called “Is There a Doctor in the House?” there is not a shortage but rather a maldistribution of primary-care physicians within the eight Hudson Valley counties. Author Kathryn Reed, who spends most of her working day as executive director for the Catskill-Hudson Area Health Education Center in Highland (AHEC), says that in the Hudson Valley as a whole there was a ratio in 2007 of one primary-care physician per 1281 persons. And in Ulster County the number is slightly better, one per 1218 persons.
Considering that the standard is that a single primary-care physician is required to serve 2400 people, it would seem a logical conclusion that in 2007 Ulster County had almost twice the number of such physicians necessary to serve its population.
Not so fast, says Reed. Her paper contends that there is indeed a maldistribution of physicians, with a clustering in the more urban and suburban areas. In fact, she says, parts of six of the eight counties have been federally designated as health-professional shortage areas (HPSAs), medically underserved areas (MUAs) or as having medically underserved populations (MUPs).
What’s going on in Ulster County? One map shows Wawarsing and Plattekill as the only towns in the county with MUA or a MUP designations. And another map shows Wawarsing and Rochester as the only HPSAs.
In terms of our personal mobility, lives are different than they were a generation ago. Many of us commute to work longer distances than we used to. We seem willing to travel further to do our shopping or to go to particular restaurants, bookstores and even gas stations. Isn’t it too much still to expect that our primary-care doctor see patients within ten miles of where we live while so many other things have changed? It may be inconvenient for us to travel to Kingston, Poughkeepsie, Newburgh or Hudson to see a specialist, but we do so anyway. What’s reasonable?
It’s incontestable that some areas are more underserved than others. For instance, it’s clear that convenient access to a doctor is a lot easier in the Kingston area than in some parts of southern Ulster County, and that the Wawarsing area has had more trouble attracting primary-care physicians than has the rest of the county. Similarly, the Poughkeepsie area is better served in terms of primary medical care than are the sparsely populated townships of eastern Dutchess County.
The village of Ellenville within the town of Wawarsing is not without institutional resources. It is home to a critical access hospital, a hospital whose job is to provide emergency care and to stabilize the medical condition of patients for up to three days. Ellenville also boasts a satellite office of the Institute for Family Health, the pioneer organization that has brought in and trained primary-care physicians for over 20 years. The community, which has adopted a serious community-based retention and recruitment plan, has been successful in raising $183,000 so far as a match against a $200,000 state grant to attract medical professionals to the community.
Thanks to Reed’s AHEC and other people’s efforts, Wawarsing, where there’s a substantial population that can’t easily afford health care as well as a situation where there’s a shortage of providers, has some recent successes to report. It has attracted four new providers: A physician who provides acute care has been added to the staff of the Eastern Correctional facility in Napanoch. Two nurse-practitioners have been credentialed to follow patients. And a local physician was successful in attracting another doctor to join his practice.
The supply and distribution of primary-care physicians is a significant part of a larger picture. But other parts of the larger picture are also dynamic. As medicine has changed, its organization and delivery keeps changing, too. There is currently great interest and considerable debate, for instance, in how the increased adoption of medical health records will change health care. State health organizations are increasingly exploring telemedicine opportunities in underserved communities. They are also advocating for improved opportunities for nurse practitioners and physician assistants.
Meanwhile, hospitals are increasingly hiring more physicians to work for them. Some specialists are returning to hospital-sponsored employment models. Hospitals are also recruiting trained hospitalists, physicians employed by them to help with hospitalized patients otherwise under the care of busy primary doctors.
For almost a generation, the local region has been blessed by the continuing presence of the Institute for Family Health (IFH), whose mission is to improve the quality and availability of family-practice services in response to the needs of medically underserved populations. At its six health centers in Ulster and Dutchess counties and at its Kingston-based residency program, this organization trains family-practice physicians, a large proportion of whom remain in the region for their entire professional lives.
Kathryn Reed, who also serves as a planner for IFH, was recently reappointed by governor David Paterson to her sixth term as a member of the New York State Rural Health Council. Wearing her various hats with aplomb, she continues indefatigably to monitor changes in the world of local health care.++