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Health care gaps grow

Booming area struggles with medical needs

http://www.floridatoday.com/!NEWSROOM/moneystoryN0205MEDICALGAP.htm

January 1, 2004
Susan Jenks
Florida Today

Her toddler has a few words at his command, but not enough to rid doctors' suspicions he may have a developmental problem.

So Margaret Casey sought out a pediatric neurologist, a specialist in the diagnosis and treatment of nervous-system disorders in children, to look at her 3-year-old.

That proved easier said than done.

Casey herself has a neurologic disorder -- multiple sclerosis -- making traveling even short distances from her Palm Bay home difficult. And Brevard County only has one pediatric neurologist who, at the time, was unable to squeeze the boy into his busy practice.

"It's scary," Casey said. "I feel so helpless."

The 42-year-old mother's dilemma illustrates one of the most-visible gaps in medical care in Brevard -- a county that, otherwise, offers residents access to many state-of-the-art therapies, including open-heart surgery and trauma care.

Although Casey has two options, both seem less-than-ideal: Florida KidCare, which provides health insurance for uninsured children, has no appointments available until midsummer, and Orlando is a difficult trek with her medical condition, she said.

"For a moderate-sized community, our tertiary care, overall, is quite good," said Dr. Ross Clevens, a Melbourne plastic surgeon, referring to medical care for the sickest patients.

"But there are definite voids in pediatric services," especially for children suspected of having serious illnesses, or those unlucky enough to have them, Clevens said.

Because one of his own children had a suspicious heart murmur, which turned out to be nothing, Clevens said, he experienced firsthand the inconvenience of having to go to Orlando for heart care for more than five years.

"With the growth of our community and more young kids, I think we do need more specialty care for children," he said. "The median age in Brevard is relatively young, compared with the rest of Florida."

Although additional gaps exist in other areas of medicine, health-care providers are quick to point out that none has yet reached a critical level. Also, they say, some services, such as organ transplants -- and the pediatric subspecialist Casey's toddler needs -- lack patient numbers to make them viable, while access to appropriate care is nearby.

"You need a specific patient base to deliver a high-quality service of this type," said Dr. Chris Finton, vice president of medical affairs and executive director of Health First Heart Institute at Holmes Regional Medical Center in Melbourne.

As a county, "we're not quite there yet," he said.

Specialities shortages

Still, some gaps in medical care are coming from physician shortages in regular medical specialties, where patients often vie for scarce appointments.

Some affect specific regions of the county, while other shortages mirror national trends that, several experts say, probably will worsen just as the nation's 76 million baby boomers need more care.

"There is a decreasing supply (of doctors) and the demand is starting to explode," said Dr. Steven Podnos, a Rockledge physician who specializes in pulmonary care.

The American Medical Association documents the biggest shortage nationally in general surgery, a high-risk specialty, often viewed as the bread and butter of the nation's hospitals.

But while the number of surgeons dipped nearly 3 percent nationwide between 1990 and 2002, other specialists, such as radiologists or anesthesiologists, saw their numbers rise but not enough to cover a 25 percent spurt in population growth, American Medical Association spokesman Robert Mills said.

Many doctors also gravitate to urban areas, where they get higher pay, help paying malpractice premiums and can start paying off an average $110,000 in medical school debt, Mills said.

That, in turn, contributes to ongoing shortages in rural areas and mid-sized communities, such as Brevard, all competing for the same doctor pool.

Limited pool

In Brevard County, 987 physicians carry active medical licenses, according to the Florida Department of Health.

How many practice full time or carry licenses in other states is unclear. And the state allows doctors to self-report an area of expertise.

Still, local shortages usually surface publicly, either because doctors and health-care providers make them known or consumers complain.

Larry Jones, chief executive officer of Brevard Professional Network, an independent physician network in Melbourne, ticked off "big holes in physicians' ranks" in urology, gastroenterology, oral surgery and general surgery.

Rockledge neurologist Dr. Richard Newman would add neurosurgery, doctors who specialize in surgery on the brain and nervous system.

"Many neurosurgeons are still leaving Florida, with some patients having to go long distances for care," he said.

Early last year, Orlando Regional Healthcare threatened to shut down its trauma center, due to difficulties getting neurosurgeons to provide 24-hour coverage, a mandate under state law.

Although the center didn't close, doctors cited complaints about limited resources, high liability costs and shrinking reimbursements as reasons for the threat.

In Brevard, four neurosurgeons serve Melbourne/Palm Bay, one serves Central Brevard and there are none in North Brevard, except by referral, hospital officials said. That means patients with the most-serious head trauma or spinal injuries usually go to Holmes, a state-designated trauma center, or to Orlando for care.

Chris McAlpine, vice president of professional services at Parrish Medical Center, said the Titusville hospital recently joined forces with Wuesthoff Medical Center, Rockledge, to hire a neurosurgeon, who will start July 1, and a second one within a year.

He said Brevard has about 100 fewer physicians than it needs. But unlike other areas of the county, North Brevard's biggest demand is for doctors who practice internal medicine, family practice or general pediatrics, McAlpine said.

"Our chamber tells us 3,000 new families are coming to North Brevard this year," he said. "It's not just retirees. There are a lot of young families as well."

Surgeon scarcity

Countywide, health-care providers say, they constantly recruit to keep pace with a fluid medical situation.

Recently, Wuesthoff's Rockledge hospital lost two of its four actively practicing general surgeons -- one to Cape Canaveral Hospital in Cocoa Beach, the other to a physician group in Melbourne.

Emil Miller, president of Wuesthoff Health System, said recruitment began immediately, with what's known as a "locum tenens" surgeon to fill the gap temporarily.

"There is no crisis here and no lack of adequate coverage," Miller stressed. "We are covered 24/7."

Several doctors blamed the situation on still-rising malpractice premiums, despite a $500,000 cap on "pain-and-suffering" awards, which was approved by the Florida Legislature in 2003.

"Unfortunately, surgery is suffering in our area," because of high malpractice costs, said Dr. Giuseppe Palermo, a Rockledge physician, specializing in cancer care. "Even before they open an office, they're at risk for bankruptcy."

Dr. Disa Sacks, a rheumatologist in Rockledge, agreed.

"I love what I do, but you can't make doctors come here," said Sacks. "The public needs to be aware we still have a malpractice crisis."

Sacks doesn't blame the hospital for the loss of its two surgeons, but she expressed concern, saying "doctors are upset."

Because the temporary surgeon just started, no one knows "how good he is," or if his weekend-only coverage will lead to disruptions in patient care, she said.
 

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