Costs of education and running a practice is pushing med students to other specialties

By William K. Alcorn


Area primary-care physicians say the basic, preventive type of family medical care they provide is key to better health and more cost-efficient medicine in the United States.

But, because of the skyrocketing cost of a medical education, inadequate reimbursement for primary health-care services, and unfunded government mandates, most physicians coming out of medical school are going into other specialities to make more money while working fewer hours.

A significant minority of primary-care doctors nationwide have seen their incomes decrease.

According to Physicians Practice 2012 Physician Compensation Survey, nearly 21 percent of primary-care physicians who responded to the survey reported their incomes dropped by more than 10 percent compared with 2011.

The growing shortage of such physicians is a big problem, said Dr. Thomas Albani Jr., a primary-care physician in Canfield who is president of the Mahoning County Medical Society.

But the shortage isn’t all about personal compensation, he said.

Primary-care physicians have always been on the lower end of the pay scale compared with other physician specialties, and they go into primary-care medicine knowing they won’t make the most money.

Rather, they are drawn to the concept of providing high-quality, comprehensive, cost-effective care for people of all ages, Dr. Albani said.

The real monetary issues are the cost of a medical education that leaves many graduating medical students with an educational debt in the six-figure range, and the prospect of operating a practice/business in the face of reimbursements that don’t cover the cost of services and uncompensated government mandates, he said.

Family-care medicine is “my love and what I practice and want to pass along to my sons and daughter,” said Dr. Walter Dombroski, president of the Columbiana County Medical Society, who has had a private practice in Salem for some 30 years.

But, he said, what has really been a big “financial hit” for primary-care physicians are the computers that are pretty much mandated for anybody who deals with the government with very little reimbursement possible.

The computers help the government track illnesses and how they are treated and identify trends in illnesses, Dr. Dombroski said.

In addition, in the last 10 years there has not been much of a raise in Medicare reimbursements, he continued.

“It’s like a tsunami coming in and lifting us up — and we can’t do anything about it,” Dr. Dombroski said.

Reimbursements through Medicare, which tend to set the pay standards for nearly all insurances, public and private, don’t cover the cost of providing services, particularly in primary-care offices, said Dr. Albani, who also is the American Academy of Family Physicians 2013 Family Physician of the Year.

He was also the Ohio Academy of Family Physicians Family Physician of the Year in 2011 and Mahoning County Medical Society’s Distinguished Physician in 2012. He is an assistant professor of family medicine at Northeast Ohio Medical University College of Medicine in Rootstown and volunteer faculty member at St. Elizabeth Hospital Family Practice Residency, and helped establish the Midlothian Free Health Clinic.

He is blunt in his evaluation of government-mandated programs, such as electronic medical records (EMR), for which he said there are inadequate reimbursement and which produce dubious benefits.

The rub, said Dr. Albani, is that “all our fees for services are set by insurance companies and Medicare ... while government and insurance companies are steadily increasing the amount of work we physicians need to do ... including more forms to fill out to beg the insurance companies to allow the medications we prescribe and the tests we order for our patients.”

As a result of the time required for paperwork, fewer patients are seen in a day or the physician doesn’t get home until late at night in order to see a full day of patients.

He described the EMR system as less a unified medium for all those in medical care to easily share patient information for the welfare of patients than it is “unparalleled ease of access to all of our patient medical records by government and insurance company watchdogs.”

Dr. Albani said he understands the need to identify and stop health-care fraud, but considers the online watchdog approach a waste of money that slows down patient care.

“I believe those committing health-care fraud are way ahead of this computerized chess game, and that those of us simply trying to care for our patients are getting stuck in the middle holding an ever-enlarging bag of government hoops to jump through.

“I’m just a solo family physician trying to take care of as many people in my community as well as I can, as cost effectively as I can. But, there is no way to keep the doors open and do our job, which should be caring for our patients rather than having to spend time and money jumping through everyone else’s hoops,” he said.

Dr. Dombroski said he is “real proud” his son, Dr. James Dombroski, a Youngstown State University and Northeast Ohio Medical School graduate, is coming back to Salem to practice with him.

Another son, Joe, is training to become an emergency department physician, and a daughter, Annie, is a second-year medical student at Ohio University School of Medicine. He said she is thinking about entering the primary-care field of obstetrics and gynecology.

“I’ve been comfortable and I’ve done well. I just don’t want my children and others to be in debt for the rest of their lives. College costs is a house-size debt without having the house,” he said.

“We all like to make a comfortable living, and specialists do make more. Also, it is simpler to study in one area of medicine. Primary-care medicine requires a wide area of knowledge,” he added.

But, he said he is all in favor of family doctors.

“I think we need more of them, especially with 30 million people coming into the health-care system under ‘Obamacare,’” he said.

The answer to better health care in the U.S. is to give everyone in the country access to a primary-care physician, Dr. Dombroski continued.

It could support preventive medicine resulting in healthier lifestyles, diagnosing conditions earlier, and keeping people away from late-stage diagnosis of cancer or diabetes, he added.

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