Health reform to test Minnesota's supply of primary-care docs, panel says

Ready or not, Minnesota health-care providers will face a slew of newly insured patients within the next year and a half, state Human Services Commissioner Lucinda Jesson said on Friday.

The question of whether the state will be ready dominated a panel discussion Jesson led on the Duluth campus of the University of Minnesota Medical School.

“It’s really going to be a sorry irony if people have the means to get our services and cannot get them” because of a lack of health-care professionals, said Jayme Collins, CEO of Range Mental Health Services, who joined representatives of the medical school, Essentia Health, the Essentia Institute of Rural Health and St. Luke’s hospital as well as Lt. Gov. Yvonne Prettner Solon on the panel.

Jesson was focusing on health-care aspects of Gov. Mark Dayton’s budget proposal in visits to Duluth and Hibbing on Friday. The round-table discussion at Lincoln Elementary School in Hibbing was devoted particularly to children’s mental health.

In Duluth, Jesson noted that the percentage of Minnesotans without health insurance is expected to be cut from more than 9 percent to 4.2 percent within the next 18 months. That stems, in part, from the Medicaid expansion bill that Dayton is expected to sign within days. The state is expected to add to the number of people covered by Medicaid by 145,000, she said, and other uninsured residents are expected to get insurance through the health insurance exchange program and other reforms.

“Are we ready to serve those people?” Jesson asked the panelists. “An insurance card doesn’t mean anything if you don’t get meaningful health care.”

Minnesota doesn’t want to repeat what happened in Massachusetts, she said, when that state’s health reforms resulted in many newly insured residents who couldn’t find primary-care doctors — those practicing pediatrics, internal medicine and family medicine.

It’s a problem already, especially in areas outside the Twin Cities, the panelists told her.

“We have a serious primary-care shortage right now in our area … that we can’t fill today,” said Dr. Gary Peterson, medical director at St. Luke’s, with eight vacancies for those doctors. “We see that as becoming more acute as the years go on.”

Although they are the most seriously needed doctors, primary-care doctors make much less money over their careers than specialists make, Peterson said.

“We have to incentivize people to go into primary care,” he said. “It’s a difficult lifestyle.”

Peterson and other panelists lauded Dayton for proposing to restore funding that was cut in 2011 from Medical Education Research Costs. Among the beneficiaries would be the Duluth Family Residency Program, which trains medical residents to serve in rural areas.

Both Essentia and St. Luke’s are spending their own money to help keep that program going, said Peterson, himself a graduate of the residency program.

But shortages go beyond primary-care doctors, panelists said. Among other shortages, especially in rural areas: psychiatrists, pharmacists and dentists.

Still, the expansion in the number of insured is a good problem to have, said Dr. Ray Christensen, associate dean for rural health at the medical school. In an interview after the panel discussion, Christensen said he thinks the system will be able to serve the newly insured.

“I was part of putting together Minnesota Care,” said Christensen, who maintains a practice one day a week in Moose Lake. “And we didn’t see a big rush of people coming in that we couldn’t handle with Minnesota Care. And it was really nice that my patient was able to come in and say: Look, I have coverage.”

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