Even though Tucson is home to an estimated 2,800 physicians, parts of the community are significantly short of primary-care doctors.
For decades, the national percentage of doctors that practice primary care—family or internal medicine, along with pediatrics—has been dropping. The American Medical Association (AMA) reports the figures went from 40 percent in 1970 to less than 33 percent in 2006.
As a result, Jeffrey Harris, president of the American College of Physicians, told a congressional subcommittee last year: "The United States is experiencing a primary-care shortage the likes of which we have not seen."
The figures for Arizona aren't encouraging. The state places 43rd in the nation in the ratio of primary-care physicians to population, according to the United Health Foundation's "America's Health Rankings."
In Pima County, there are an estimated 500 doctors who practice primary care. That ratio of .5 primary care physicians per 1,000 population is less than half the national average of 1.2.
The reasons for the decline in primary-care doctors are numerous. One is that these physicians reportedly make only 55 percent of the income that medical specialists earn. Another is paperwork and time constraints in their medical practice.
Earlier this year, the UA College of Medicine graduated 110 doctors, 42 of whom were going on to residencies in primary care. That compares favorably to national statistics indicating that fewer than 20 percent of U.S. medical students are going into primary care.
Dr. Kevin Moynahan, deputy dean of education at the UA College of Medicine, says of the situation: "The need (for more primary care doctors) is obvious. We really are trying."
Nathaniel Rial, a 2009 UA College of Medicine graduate, is currently a primary-care resident and plans to continue in the profession. Even after finishing his residency and a four-year commitment to the Navy, Rial says: "I'll likely stay in primary care, because there is such a shortage."
That severe lack of primary-care doctors can have a range of serious ramifications. As the AMA concludes: "Patients will experience reduced access to primary-care physicians due to growing shortages."
That's not an encouraging outlook for Tucson's chronically overloaded emergency rooms. To reduce this ER burden, people are often encouraged to use primary-care doctors instead. But if those doctors are not available, what's a person to do?
The lack of primary-care physicians in some sections of town is one reason why they're designated as Health Professional Shortage Areas (HPSA) by the federal government. That classification additionally means they are automatically listed as Medically Underserved Areas (MUA) by the state of Arizona.
Two Tucson HPSAs begin near Valencia Road to the south and stretch eastward from Interstate 19 to close to Alvernon Way. From there, they narrow down toward a point on the northside near Grant Road and Interstate 10.
Another geographical HPSA is found in parts of the town of Marana.
Steve Nash of the Pima County Medical Society points out problems for some people living in these HPSA areas—even in our highly mobile community.
"If they're on a bus," Nash observes of those without automobiles, "it can be difficult to get to a doctor. That can be a disadvantage."
One reason Nash cites for the shortage of primary-care physicians in some parts of town is the current land-use congregation of medical offices around hospitals. As he points out, only one public hospital is located south of Broadway Boulevard.
Nash also says he's particularly worried about the lack of primary-care physicians in rural areas. "Doctors really seem to be declining there," he says.
But even in metropolitan Tucson, the lack of primary care doctors can be pronounced.
In portions of the south-central part of town, 2009 figures from the Arizona Department of Health Services (ADHS) indicate there are just 51 primary-care doctors in the area, for 68,000 residents. At the same time, 30 percent of the people in this geographical area are living below the federal poverty level. Perhaps not coincidently, the premature mortality rate here is 36 percent higher than the Pima County average.
Supplementing the federal government's interest in identifying and dealing with the primary-care doctor shortage in HPSAs, the state of Arizona has its own program. Patricia Tarango of the ADHS indicates a new report on Arizona MUAs should be on Gov. Jan Brewer's desk by Oct. 1.
The HPSA designation can lead to some benefits. "There are safeguards, to center more resources (in an area)," Tarango says of the classification. These resources include both federal and state funds to encourage doctors to practice in these underserved areas.
The federal government, she says, has a loan-repayment program of $50,000 for primary-care doctors and others who work full-time in an HPSA for two years. There's also a highly competitive national scholarship program for medical students that assists 800 to 1,000 students annually.
"There's been significant interest in these programs since March," Tarango says. "The new (federal) health-care reform legislation has put (in) significantly more dollars to gain doctors in these areas."
That might mean the parts of Tucson now classified as HPSAs could eventually lose that designation.
"If they lose it, that's a good thing," Tarango says.