Delaware, don't lose your primary care doctor

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As a primary care physician who lives in Hockessin, Delaware, and practices in Wilmington, I am often called upon to help friends, family, and patients in times of need. Today, I am taking a chance by calling on your help.

Delaware is in a primary care crisis. What this means is that there is a shortage of primary care doctors (Internal Medicine, Family Practice, and Pediatrics) to serve Delawareans. I personally know friends in our community who haven't been able to find a new doctor since their own physicians have had to shut down their practices or have moved out of state. Their doctors have had to find alternative ways to stay financially afloat.  New patrons of the practice I work for often report they called many different practices before they found one accepting new patients.

You may think that the answer is simple by replacing physicians with independent nurse practitioners or by creating more jobs for physician assistants in primary care. However, even nurse practitioners and physician assistants are leaving primary care for less stressful and more lucrative positions with specialists. 

Why, you may wonder, are there fewer and fewer primary care providers in Delaware? Not surprisingly, the underlying problem is a financial one. In Delaware, reimbursement rates by commercial insurance companies for primary care services are far lower than the national average. Most insurance companies reimburse 20-30% higher than Medicare rates. In Delaware, the rates of reimbursement are 15-35% LOWER than Medicare. Some commercial insurance companies reimburse even lower than Medicaid rates. This is not surprising given that most commercial insurance plans in Delaware are only budgeting 3% of their spending towards primary care; by contrast, the national average is 6-8%. When insurance companies lower the rates of reimbursement for these visits, providers must see more patients in a day to keep their practices afloat. Patients become understandably dissatisfied with shorter office visits and physicians, scrambling to see more and more patients, run the risk of burnout. The logical solution for the provider, thus far at least, has been to practice “concierge medicine” which serves a few hundred patients rather than a few thousand patients or to leave Delaware altogether to practice in a neighboring state where reimbursement rates are better.

Fortunately, Senator Bryan Townsend and the Health Committee have listened to our concerns. They introduced Senate Bill 227 which increases the rates of reimbursement by commercial insurance companies to primary care practices to match what Medicare provides.  On June 13, 2018, the Bill passed the Senate and is moving on to voting in the House of Representatives.  I urge our legislators to vote in favor of this bill so that practices can attract more providers to the area and serve more patients. Patients will not have to wait months to be seen by a doctor. Patients will not have to wait endless hours in an emergency room waiting room for things that can get handled by their primary care practice. And most importantly we will have taken the first important step to secure the health of Delawareans.

Jayshree Tailor, M.D.

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