New Jersey's policies toward primary care physicians are decimating its ranks and deepening a public health crisis.
Primary Care Physicians in Crisis
If you live in New Jersey, arguably the greatest threat to your health and welfare is not pollution, contamination or disease. It's healthcare policy driving your family doctor out of state or out of business.
A policy that is so adverse to primary care physicians – those who care for people 18 and older - that of the 1,761 primary care physicians training in New Jersey teaching hospitals in 2015, more than 99 of 100 chose to leave New Jersey upon graduation according to the New Jersey chapter of the American Association of Family Physicians (AAFP).
It gets worse. Virtually no doctors move to New Jersey and most of the primary care physicians who put down New Jersey roots decades ago are approaching or past retirement age. The situation is so bad that New Jersey specialists now outnumber primary care doctors by almost 10 to one. That leaves New Jersey near dead last for primary care physicians per capita in the United States and its territories, at triple the national average at just one adult primary care physician for every 3,760 adults.
Conversely, there is one specialist, from allergy to oncology and beyond, for every 387 New Jersey citizens. The national average is nearly double at one for every 714.
America's most vulnerable population, our seniors, have a primary care doctor for every 192 seniors nationally, New Jersey seniors have one doctor for every 657.
Why is this important?
According to the New England Journal of Medicine, "Greater use of primary care has been associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality."
That's a healthcare jargon way of saying that there is a mountain of evidence worldwide that when there is a shortage of primary care physicians, people pay more, suffer more, and die more.
This is all because of the different roles primary care and specialist physicians have. Specialists are experts at treating a specific condition, usually in its acute phase. Primary care physicians are experts at preventing, slowing, stalling and even reversing all of a patients' conditions.
Simple logic leads to cause and effect. If there are too few primary care physicians, chronic disease often progresses unrecognized, untreated, and unabated to acute phases because the few physicians left are too busy to manage them.
An ample supply of sick people requires even more specialists and fuels hospital growth with more diagnostics, procedures, and inpatient stays. Then hospitals start to buy specialists to supercharge their growth and everyone feels good about themselves because they are helping so many sick people.
When it comes to underfunding primary care, New Jersey's disparity with the rest of the country is as stark a warning as its primary care graduates fleeing the state.
Medicare reimbursement is the baseline, a regional market-basket average of costs of providing services. Commercial insurance supplements Medicare and Medicaid throughout the rest of the country - except in New Jersey. Except for hospital systems with their overwhelming bargaining power, New Jersey commercial insurers pay primary care providers a fraction of Medicare, as little as 60 percent by large insurers, and, a crushing 40 percent by Medicaid.
That means citizens of New Jersey pay with their health, welfare, and lives.
This is not just a needless human and financial tragedy, it is a political failure of disturbing proportion driven by deep pocketed, aggressive special interests.
The following policy changes will start to set things right:
1. Invest in recovering primary care in New Jersey by matching non-hospital employed primary care fee reimbursement to hospital reimbursement to keep them as independent patient advocates and clinical managers.
2. Require commercial shared savings programs to deliver minimum results in cost, quality and clinical outcomes to continue to participate. Shared savings payments can be substantial, and failed programs do not support physicians.
3. Pay primary care student loans from a state fund if new graduates commit to and stay and practice in New Jersey for so long as they stay and practice here.
Doing the right thing for New Jersey by supporting primary care should not be a hard thing for the state legislature and administration to support in a bipartisan manner.
For the past eight years, New Jerseys' legislature has rebuffed every attempt, even the watered-down ones, to fix this problem and other equally serious healthcare issues, folding under pressure from special interest groups time after time.
The latest, Assembly bill A1952, proports to protect New Jersey from predatory out-of-network billing – sort of. More on that in the next installment.