Trends in physician office visits shift as money worries affect behavior

A Florida doctor has seen patients in his office with broken wrists or hips. "These people would have generally gone to the emergency department."

By — Posted March 5, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The economic downturn has kept many cash-strapped patients from seeing their physicians or caused many to delay treatment, research has shown. Studies and reports from doctors provide insight into how patient behavior has been affected by the 2007-09 recession and its slow recovery.

For example, a poster presented Feb. 7 at the American Academy of Orthopaedic Surgeons meeting linked increasing unemployment rates in Tampa, Fla., with a decrease in patient volume at a level 1 trauma center. When unemployment went up, orthopedic trauma volume went down, from a peak of 2,065 cases in 2007, just before the recession, to 1,743 in 2009 when it was in full force.

These patients are usually so severely injured they don't decide where or whether to receive medical care.

"We're still very busy," said Daniel Chan, MD, lead author and an orthopedic surgeon with the Florida Orthopaedic Institute in Tampa. "It's not a huge difference, but it is enough to notice."

Construction is one of the top 10 most dangerous occupations, according to the Bureau of Labor Statistics. But construction was hard-hit during the recession, particularly as new-home building -- an economic staple in Florida -- dried up. A total of 86,700 people worked in construction in the Tampa area in 2007. The number decreased to 59,200 in 2009.

For less severe traumatic injuries or illnesses, physicians report that patients are trying to treat themselves or receive care in venues that may be less costly or more convenient than the emergency department. Nevertheless, statistics have noted an increase in emergency department use. The Centers for Disease Control and Prevention said the number of ED visits grew from 124 million in 2008 to 136 million in 2009, the largest growth on record. But primary care physicians say that cost concerns are bringing more emergency cases to their practices.

For instance, Sergio B. Seoane, MD, a solo practice family physician in Lakeland, Fla., said more people have come into his office with broken wrists in the past 18 months than during the past decade. Two patients even limped in with broken hips.

"They are calling and seeing if they can come in today or the next day," Dr. Seoane said. "That never happened before. These people would have generally gone to the emergency department."

In such situations, he does the x-ray in his office and refers them to the emergency department or a specialist.

Physicians who run urgent care centers also have noticed growth in patient volume because convenience has become more important than ever as people fear losing a job if they take too much time off from work. Some of this growth has been tempered by patients putting off accessing services or trying to care for themselves.

"Patients are self-medicating," said Nathan Newman, MD, a family physician and chief medical officer with Solantic, which runs 32 urgent care centers in Florida.

Industry watchers say these trends may continue even if the economy recovers, because patients with employer-provided health insurance are paying more out of pocket for care.

"It's not clear whether we've reached a new normal or this really is a function of the economic downturn," said Larry Levitt, senior vice president of the Kaiser Family Foundation. "Even if the economy comes back, cost-sharing is not going to go down."

A report issued Nov. 15, 2011, by the Kaiser Family Foundation said visits to physician offices by insured patients declined 17% from the second quarter of 2009 to the second quarter of 2011 to 129 million visits.

Although workplace injuries have decreased during the recession, "the message is not that unemployment is good for us," said Ellen MacKenzie, PhD, professor of health policy and management at Johns Hopkins University in Baltimore and former director of the institution's Center for Injury Research & Policy.

Meanwhile, the number of people injured because of violence in the workplace has been edging up, from 16,560 in 2003 to 16,910 in 2010, according to the BLS. The agency recorded 180 workplace suicides in 2005, when the economy was doing well. That grew to 258 in 2010.

Other studies have documented increases in injuries related to abuse and violence as well as significant impacts on mental health.

A report in the October 2011 Pediatrics found that the number of children under age 5 treated for abusive head trauma went up during the recession. A study in the December 2011 American Journal of Public Health linked mortgage delinquency among people over 50 with an increased risk of symptoms of depression, worse health status and problems accessing care. A report in the November 2011 Psychological Medicine correlated home foreclosure rates with symptoms of major depression and generalized anxiety disorder.

Back to top


The upside of recession: Auto fatalities drop

Several studies suggest that economic downturns affect people's behavior and, in turn, their health. They may drive less and take fewer risks. This can translate to a lower number of traffic crashes.

There were about 20% fewer fatal crashes and traffic fatalities in 2009 than in 2004.

Measure 2004 2005 2006 2007 2008 2009
Fatal crashes 38,444 39,252 38,648 37,435 34,172 30,797
Total fatalities 42,836 43,510 42,708 41,259 37,423 33,808
Fatalities per 100 million vehicle miles traveled 1.44 1.46 1.42 1.36 1.26 1.14
Fatalities per 100,000 population 14.6 14.7 14.3 13.7 12.3 11.0
Fatalities per 100,000 licensed drivers 21.5 21.7 21.1 20.1 18.0 16.1

Source: National Highway Traffic Safety Administration, Fatality Analysis Reporting System (link)

Back to top

Workplace injuries decrease in economic downturn

Injuries in the workplace can change in a recession. Employment in more dangerous industries may shrink, and this can translate to a lower number of workplace injuries. Stress, however, may come out in different ways, increasing mental health issues and workplace violence.

Workplace injuries in 2010 were at about three-quarters of their 2005 levels.

Injury 2005 2006 2007 2008 2009 2010
Workplace fractures 95,830 94,110 94,950 89,650 75,070 69,380
Per 10,000 workers 10.5 10.2 10.0 9.4 8.3 8.0
Sprains, strains and tears 503,530 472,740 448,380 416,620 379,340 370,130
Per 10,000 workers 55.3 51.1 47.3 43.8 41.8 42.7
Injuries from assaults and violent acts 14,560 15,970 16,840 16,330 15,450 16,910
Per 10,000 workers 1.6 1.7 1.8 1.7 1.7 2.0
Workplace fatalities 5,734 5,840 5,657 5,214 4,551 4,547

Fatality numbers for 2010 are preliminary.

Source: Bureau of Labor Statistics, injuries, illnesses and fatalities program (link)

Back to top

External links

"Do Changes in the Economy Impact Orthopaedic Trauma Volume?" poster presented at the Orthopedic Trauma Assn. Oct. 12-15, 2011, and at the American Academy of Orthopaedic Surgeons annual meeting, Feb. 7 (link)

National Highway Traffic Safety Administration, Fatality Analysis Reporting System (link)

Bureau of Labor Statistics, injuries, illnesses and fatalities program (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn