More doctors for a growing Valley

Growth here is outpacing the national average, but Idaho still is playing catch-up with the rest of the states

By Colleen LaMay

Treasure Valley residents have more choices than ever when it comes to picking a physician. In the past decade, the number of physicians licensed in Idaho has risen by 35 percent, a growth almost twice the national average, to 3,869 from 2,869. Much of that growth has been in the Valley.

"We’re growing a lot right now, and the market is growing as well,’’ said Laura Rowen, primary care program manager for the State Office of Rural Health and Primary Care. "It could translate to more and different services and specialty care, where in the past you may even have had to leave the state.’’

Dr. Mikael D. Lagwinski, of the Idaho Arthritis and Osteoporosis Center, is one of the newer doctors in town. He came from Texas and practices in an office at St. Luke’s Meridian Medical Center. Lagwinski, an internist who subspecializes in rheumatology, mainly was attracted to the Valley because managed care isn’t as big here as it is in other parts of the United States. That allows him more freedom to treat patients the way he believes is best, he said.

Plus, "I knew there was a real need here." Rheumatologists, who treat arthritis and other autoimmune diseases, are in short supply, according to the Idaho Medical Association

The young doctor also liked the qualities that attract thousands of other people to the Valley, including the low crime rate, relatively smooth traffic and active lifestyle. "It was quite a welcome change for me," he said. His office, where he practices with Daryl K. MacCarter, was conducting nine clinical trials of medications for rheumatoid arthritis and other diseases. "The field of rheumatology has had something of a renaissance these past few years," Lagwinski said. "It’s an exciting time to be a rheumatologist."

We’re still short of doctors

Despite the tidal wave of new practitioners in the Valley, the per-capita number of doctors statewide remains among the lowest in the nation, partly because Idaho lacks a medical school, which could train doctors and encourage them to stay put afterward. A special program allows some Idaho students to attend medical schools at the University of Utah and the University of Washington without paying out-of-state tuition.

The need for more doctors will only increase as our bodies age and demand more attention. The 65 and older set is projected to grow 117 percent from 2000 to 2020, while the state’s population as a whole is expected to grow only 29 percent during the same time.

One of the most critical shortages, statewide and in the Valley, is psychiatrists, according to Bob Seehusen, chief executive officer of the Idaho Medical Association. The state lacks a residency training program for those doctors and suffers a chronic shortage of crisis beds for psychiatric patients. The state’s suicide rate consistently ranks among the highest in the nation. (Click here to link to a detailed, state of Idaho report on suicide in Idaho.)

To ease the shortage, health officials are developing a partnership between the University of Washington in Seattle and the Boise Veterans Administration Medical Center for a residency training program for psychiatrists. Doctors would train not only in Boise, but also in rural Idaho, where the shortage is even more extreme than in the Valley. Officials hope some of the doctors will stay in Idaho when they finish their training.

The Idaho Legislature will be asked this year or during the 2008 session to put up about $150,000, or 10% of the annual $1 million cost of the program. Boise hospitals, along with the U of W School of Medicine and the VA, will pick up the rest of the tab.

"Things are moving," said Seehusen. "We’ve still down near the bottom on total doctors per capita, but psychiatrists are definitely at the bottom, and access to mental health (care) is a major priority of the Idaho Medical Association," Seehusen said. "It truly is the weakest link," he said.

In general, the Treasure Valley is heavy on doctors who do procedures, such as eye surgeries, and short on doctors who provide primary care, such as family practitioners. That’s because doctors get paid more when they do procedures, and doctors have bills to pay, just like you and me, Seehusen said.

"There’s not a whole lot of incentives for a young doctor to necessarily opt for those primary care specialties," Seehusen said. "It’s harder to recruit people these days, when their own specialty is not keeping up with the cost of providing medical care."

Patients who lack health insurance or rely on Medicare or Medicaid face greater challenges finding a physician. Many doctors limit the number of such patients in their practices.

How to choose a doctor

Insured patients looking for a doctor first need to make sure the one they choose is covered by their health insurance. You often can verify that through a physician office or on your insurer’s Web site. In the Treasure Valley, where managed care never got much of a foothold, many people can see the doctors they choose. Here is some advice from Seehusen about choosing a physician:

Ask friends, neighbors and relatives about their experiences. "They can certainly tell you about somebody, and that’s not a bad way to go," Seehusen said.

It’s best to choose physicians who are board certified in their specialties. That information is available from the American Board of Medical Specialties and the Idaho Board of Medicine and through links on other Web sites. (See box at right.) "That certainly is an indicator of their clinical training," he said.

How many procedures has your physician done? More is better. It hones skills. "Highly skilled doctors are highly skilled because they have done this many, many times," Seehusen said.

Dr. Patrice Burgess, medical director of physician relations at Saint Alphonsus Regional Medical Center in Boise, advises patients to interview prospective doctors to see if their communication styles are a good fit. Patients seem to do that more often when picking a pediatrician to see their children, but the same advice can work for grownups’ doctors as well, said Burgess, who also practices part time at the Family Medicine Residency of Idaho.

Some patients want lots of choices. Others simply want to be told what to do. It eases the way for patients and doctors alike to know which style works best. "Sometimes we are sitting there trying to give people all these choices, and we are just annoying them," Burgess said. Some insurance requires a referral from your family doctor, but even if it doesn’t, it’s best to go through your primary physician anyway, she said.

What’s the best way to get in to see a specialist whose calendar is booked months in advance? "I think that one thing from a consumer perspective is to make sure you check in with your regular care doctor first, because you might not need to see the specialist, or maybe not so quickly," Burgess said.

Your family doctor also may be able to get you an appointment sooner than you could get it for yourself and can provide specialists with medical records they will need to treat you. Your doctor also can help with pain control and other measures until you can see a specialist, she said.