A Lack of Access to Specialty Care
By CYNTHIA YELDELL ANDERSON
A Physician's Appeal for Help Serving the Underserved
When Concepcion "Conchita" Martinez, MD, signed on as lead doctor at Total Health Medical and Dental in Antioch, she hoped to replicate the success at Medicos that operated seven days per week serving the Hispanic community, which at one time had up to 20,000 patient visits per year.
"That's what I want Total Health to be ... comprehensive, affordable care with or without insurance, " said Martinez, noting that Total Health has doctors, nurses and support staff who all speak Spanish.
Since joining Total Health last October, Martinez said business has been good, but she has noticed her biggest challenge is finding specialists for patient referrals. As a primary care physician, Martinez said she can treat 90 percent of medical issues that come through the door, including prenatal care, ultrasounds, vaccines, X-rays, well child visits, gynecological procedures, minor surgeries and more. However, there are times when Martinez has to refer patients to a specialist, and many patients wind up with long waits. During this period, Martinez said patients often see their conditions worsen. "Specialists have been traditionally hard to get into," Martinez said. "The reason why is because of lack of insurance, and insurance that is not accepted by many specialty offices."
Total Health is a part of Meharry Medical Group, which does offer specialty care, and Meharry specialists do see Martinez's patients eventually. However Martinez said there is a real need for more specialists that accept uninsured and underinsured patients in the Nashville area and around the country.
"The specialists at Meharry are excellent, but there are only so many of them," Martinez said. "There are specialty areas that are underrepresented such as urology, hematology, oncology, rheumatology, nutrition, plastic surgery, and others."
She added it could take three months or longer for her patients to get in to see a specialist as she refers throughout Nashville. "Sometimes I get on the phone and call the doctor and ask them to see my patients," Martinez said. "The last patient I had that needed a vasectomy had to wait six months. It's hard to get patients in. The specialists are overwhelmed."
Martinez said some patients become so frustrated that they stop pursuing specialty treatment. Instead, they let their condition worsen until they ultimately end up in the emergency room, which leads to poorer health outcomes and more costs for the patients and healthcare system, she pointed out.
"That cost is huge, and it's not optimal care," Martinez said, adding preventative services like treatment for depression or mental illness also are often missed when patients go to the ER for treatment. "The emergency room is not a good way to take care of yourself. The emergency room is not interested in your diet or your day-to-day health. That's not their purpose."
Millard Collins, MD
Millard Collins, MD, chairman of the Department of Family and Community Medicine at Meharry Medical College, said the problem with access to care is not only impacting the uninsured, but he's sees many working people with high-deductible insurance plans who are reluctant to go to the doctor because they can't afford their deductible. He said this problem with access to care is not unique to Dr. Martinez or Meharry.
"It's a problem in Nashville and every city where there is a divide between rich and poor," Collins said. "Meharry, since 1876, has always addressed issues of health disparities. Nashville is a city that's continuing to grow. The problem will only get worse as more people move into Nashville, so it's best that we start to address it now."
Contributing to the problem, Collins said, is the fact that fewer doctors are business owners who have the autonomy to make decisions on their own. As solo practitioners disappear, he said, business managers make the decisions about which insurances and payment methods are accepted, and physicians often aren't involved in the policy decision-making process.
"It's part of the corporatization of medicine," said Collins. "There are some very good specialists in Nashville. When they are in a group with 20 or so other specialists, it's not always their decision."
Collins said Meharry and Total Health see cash patients and will provide care to patients regardless of their insurance status. He offered a challenge to other area specialists to make a greater effort to be more accessible.
"We want people to remember why they started this journey to be a physician," Collins said. "We start medical school as idealists and get lost along the way. It's our hope that if any specialists are willing to partner with us, they will contact the Meharry Medical Group."