New Orleans now a physician shortage area

The federal government officially has recognized what many already knew about New Orleans: The city is short on physicians, as well as mental health workers and dentists.

The Health Resources and Services Administration Bureau's Health Professions National Center for Health Workforce Analysis recently designated Orleans Parish a health professional shortage area, a label that will give New Orleans physicians a 10% increase in Medicare reimbursements for certain services.

The designation also opens up the city to newly trained physicians looking for loan repayment options or visa waivers through the National Health Service Corps Loan Repayment and Scholars Programs, J-1 visa waiver programs and the State Loan Repayment Program. Within days of the late April announcement, the state's J-1 visa waiver program received three new applications for New Orleans.

Pockets of New Orleans held the HPSA designation before Hurricane Katrina. The city also covers Jefferson and St. Bernard parishes, with St. Bernard already declared a HPSA since the storm. To be named a shortage area, Orleans Parish had to have no more than one primary care doctor for 3,000 residents, one psychiatrist for 21,000 people and one dentist for 4,000 city dwellers.

Roberto E. Quintal, MD, president of the Orleans Parish Medical Society, sees the HPSA designation as one more step toward rebuilding the city.

"I think it will make a difference," Dr. Quintal said. "How big a difference? Nobody can predict. For the physicians who are currently here and who have gone through so much trouble to stay, the increase in reimbursement will help them out. Since many of the physicians who left were younger physicians, we hope the J-1 waiver and loan repayment programs will be enough inducement to bring some who are on the fence to make the decision to come to New Orleans."

Dr. Quintal, a cardiologist, said that although hospital beds are at a premium at any given time, the health care infrastructure is functional, office space is reopening and physicians are able to perform the same procedures and treat the same complexity level of patients as they did before Katrina.

"I expect and hope that at the end of the school year, hopefully many of the doctors will try to come back," he said. "The challenge is not only office space, but living accommodations. A great part of the city is not rebuilt yet."

According to Louisiana's Bureau of Primary Care and Rural Health, Orleans Parish has 140 primary care physicians, down from 617 before the Aug. 29 hurricane. The number of licensed psychiatrists is now at 22, compared with 196 before Katrina, and the number of dentists is 77, down from 228 before the storm.

Coming home

Madeline Feldman, MD, a rheumatologist, moved back to New Orleans in January after evacuating to Houston. She isn't sure if she'll benefit from HPSA designation.

"Ten percent of zero is still zero," she said. Because much of the city's population has yet to return, there aren't many patients to see.

Dr. Feldman's income is less than half of what it was a year ago, and she's gone from a schedule booked for three to four months to one where patients can walk in. She stills hears of physicians leaving, though she is optimistic that the situation will improve.

Floodwaters took everything at both locations of the multispecialty group where she practiced.

She's joined two other rheumatologists in a new practice. She said each of them benefited from the stipend the American Medical Association gave to help New Orleans physicians recover. "We're very grateful for that," Dr. Feldman said.

She's stopped tearing up as she drives to work past the grim brown line the flooding left on miles of buildings, but the toll of the storm continues to weigh on her patients.

"Some patients, we haven't seen each other since last summer," Dr. Feldman said. "I'll walk in and they'll be crying, [saying] 'Dr. Feldman, it's so good to see you.' It's heart-rending. You realize how important you are to your patients. ... That's a good feeling money can't buy."