Last Tuesday, Fort Waynes Dr. Thomas Kintanar had one of those days.
After a patient had a sudden heart problem that required hospitalization, Kintanar found he was more than two hours behind in seeing patients at his office.
I felt bad about it, the family practice physician said. We always feel bad when we make patients wait.
But such is the state of primary care today in Fort Wayne, where patients find theyre visiting doctors with larger caseloads, enduring longer waits for non-emergency appointments and getting less face time as doctors routinely juggle appointments for upwards of 35 patients a day.
Some patients might even find themselves turned away by doctors who have pruned their rolls of inactive patients or stopped accepting new ones.
We were just about ready to do that, but I have a philosophical difficulty with that, turning patients away, Kintanar says. Still, he adds: There gets to be a saturation point.
Dr. Reshma Khatri, a pediatrician who moved from Ohio to practice in Fort Wayne about six months ago, says some established area pediatricians are so busy that they can see upwards of 60 kids a day.
Because her practice is new, she sees 15 to 20, but she says some patients come from long distances.
There are patients who come in from Allen County, and I do have patients coming in from farther out than that just because they hear theres a new pediatrician and theres none in their area, she says.
With a ratio of one pediatrician to every 1,900 children, Fort Wayne is better served than the rest of Indiana, where the ratio is one to 2,700, Khatri says.
Still, the citys ratio is worse than that of the rest of the United States, which has one pediatrician for every 1,400 children.
A 2008 study by Indiana Universitys Center for Health Policy found statewide and regional shortages in primary care practitioners, which in the study included pediatricians, family doctors, internists, osteopaths, nurse practitioners and physician assistants.
The ratio in the Fort Wayne area ranged from 41.4 practitioners per 100,000 people in Wells County to 13.2 in LaGrange County. The optimal number, according to the study, is 48.
Allen Countys ratio was 36.3. Dekalb followed at 31.4, Elkhart at 28.6, Kosciusko at 27.8, Huntington at 22.3, Steuben and Wabash both at 20.0, Whitley at 19.6, Adams at 17.8 and Noble at 15.5.
Dr. Jim Stapel, chief medical officer for Parkview Physicians Group, says changes in the ways primary-care doctors do business may ameliorate the effect of any shortage in their numbers.
Doctors today are making more use of time-saving electronic medical record and associated professionals such as nurse practitioners and physician assistants, he says, and he expects that to continue.
A lot depends on what health care looks like going forward, but I think health care will be delivered in a team-based (care) model instead of an individual physician meeting all the needs of that patient, he says.
David Hunter, chief operating officer for Parkview Noble Hospital in Kendallville, says an active family practice residency program in Fort Wayne has helped him recruit over a dozen new primary-care physicians in the past eight years.
The reason weve been successful is were part of a bigger system and also have a new hospital with the latest technology, he says.
But my best sales people are other doctors who tell (new recruits) what practice is like in Noble County and how great it is to live in this area and raise a family.