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Family doctor worries about physician shortage

Scott Scanlon – Refresh Editor

Dr. Amy Burke comes from a blue collar background in
suburban Syracuse.

Her dad, Edmund, worked at GE in Syracuse and retired
about the time the factory closed there.

“He was the best father ever,” she said. “My dad worked a
second job just to pay for my braces. He was a janitor. He was a typical Irish
Catholic who taught you how to work hard.”

Her mom, Bonnie, stayed home while Burke was growing up, then
went back to school and became an LPN who worked primarily with elderly patients.

Some might say Burke was born and raised to be a family
doctor, the kind that tends to be on the lower rung of the pay scale when it
comes to physicians, but who arguably is the oil that helps keep the machinery
of medicine running as smoothly as it does.

Could the U.S. health care system run much more smoothly?
Anyone who’s dealt with a chronic health condition the last couple of decades,
or their family members, knows the answer to that.

One of the problems: Primary care doctors are among physicians in short supply across the country, as well as in Western New York, and their role is expected to become even more crucial as more parts of the Affordable Care Act roll out in coming months.

“When I was in medical school, there were 140 graduates,”
Burke told me for an “In the field interview in today’s WNY Refresh. “The
number of people who went into primary care, family medicine, was eight. All
the specialties get paid more, but the primary care area is so short of
doctors. We’re not incentivizing people to go into primary care.”

Here’s what she said about the Affordable Care act when
it comes to family docs:

“Less than 10 percent of the American people don’t have
insurance. That’s about 24 million people, so 300 million have some form of
insurance. So 24 million people are going to get insurance. What primary care
doctor is going to see these people? There are no doctors taking patients in
the Southtowns besides me. I’ve been getting 10, 12 new patients a day. I’ve
only been open three months. You can only safely take care of so many people.

“So now there’s 24 million people over the next couple of years who are going to be introduced into the health care system, and the payment plan is going to be less and there’s going to be no one to take them. So here’s Obama … advertising this wonderful health care program but what he’s forgetting is what about incentivizing primary care? Because 10 years down the line, I don’t care if you give them insurance, who are they going to see?

“The average age of a primary care doctor is in the
low-60s. What’s going to happen five years from now (when doctors start
retiring)? Recruiting doctors in Buffalo? Are you kidding me, when they can go
to Miami and California? So finding a doctor is so difficult. The only people
who stay in Buffalo are Buffalonians, so how do we incentivize people in
medical school to go into primary care and then stay in Buffalo?

“If you really want more preventative services, you have
to have the doctors to do it. ... I think loan help: ‘Hey, we’re going to give
you a stipend if you do primary care.'

"The cost of services for people who don’t have preventative health care, that’s what’s breaking our system. People who don’t go to the doctor – and some people think it’s because those people don’t have insurance – they have insurance. People come into my office and say, ‘I haven’t been to a doctor in over a year because my doctor is gone and you’re the only doctor who’s taking primary care patients. I’m telling you, in less than six months my door will be closed because you can only take so many patients.

"If I have a really old population, I can take care of maybe 3,000 patients, and what that means is that when you’re sick you can get in...

“There’s talk of the federal government forcing doctors to take more patients. That’s crazy talk.

“Still, to me it’s about quality and I think that’s what Affordable Care is going to bring in.

"There’s lots of numbers. We’re trying to come up with a good balance and that balance should be centered on the patient. Yes, we need to pay our bills, but if you lose sight of that patient, you’ve lost.”

… I’m unhappy in that (numbers) system, so I’m going to work hard and make my practice successful. Am I going to make huge margins? No I’m not. But I’d rather make patients happy, and be happy, than work in a system where they don’t even care what I have to say, just ‘See 20 patients, squeeze them in. See 30 patients a day.’

Here’s what else Burke had to say:

Why did you decide to start your practice in Orchard Park?

There’s not many doctors accepting new members. Plus I admit to Mercy Hospital, which is pretty much a Southtowns hospital, and all my consulting physicians are only about five times away from me, so it really made sense to stay in the Southtowns.

What have been the biggest challenges?

Getting someone like Stacey Nicholas. She’s an LPN, but she knows ordering this, and ordering that supply. She knows how to do this. I needed her. My other challenge, I have a business plan. My challenge was getting the money to do it.

What are the pleasant surprises so far?

I’ve always liked taking care of patients, but what I have found having my own practice, there’s something different about that. I’ll take care of a woman and she’ll say, ‘My husband and my daughter want to see you because I like you so much.’

Plus many of their colleagues have sent their families to me. … I feel so honored.

What is it like to treat patients who are much older than you?

I thought about doing family medicine because I absolutely love children but I realized I absolutely love older people, too. I realize they’ve done so much in their lives. A 90-year-old has gone through generations of changes. … The older patient tends to respect the doctor a lot, although they will make comments like, ‘Are you old enough to take care of me?’

What so far has been the funniest thing you’ve experienced?

I tell patients I went into medicine as my second career. My first was a standup comic. Now you have to pay me, and listen to my jokes.

When a husband and wife come in, I always turn to the husband and say, ‘You robbed the cradle.’

Often times, women will come into appointments alone. Older men, the wife is always there and she’s always in the background like this, shaking her head (no) while her husband is talking.

What has been the most rewarding thing so far?

There was a patient I really took care of for a while at another practice. She was in the hospital and had a bad stroke. We decided to put her on hospice care. The whole family came, and after she died, they just hugged me to know that I helped to make someone comfortable toward their end. It’s
about the memories that families will have as they go on, that when they think about the death of their mother, they’ll think about a doctor who helped them. … Just listening. That’s all it took.

Maybe because it’s that my mom died suddenly at 54, my dad died in hospice, that I’m very personal with my patients. Sometimes it’s good to say to your patients, ‘I understand, my dad died in hospice.’

What top three tips can you give on how people can stay as healthy as possible?

Don’t smoke, lose weight. Do what you love. If you’re going to be a doctor, love it. If you’re going to flip burgers at Burger King, love it. Because when you’re happy, everything’s fine. You’re more likely to be healthy, to lose weight…

Be inspired.

email: refresh@buffnews.com

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About The Refresh Buffalo Blog

Scott Scanlon

Scott Scanlon

Scott Scanlon is an award-winning reporter and editor who has covered various topics in his quarter-century as a journalist in South Florida, Syracuse and Buffalo. He is aiming to pass along what he is learning these days about health, fitness, nutrition and family life.

@BNRefresh | refresh@buffnews.com

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