"Thenearly 6,000 is the approximate number of physicians doing primarilypatient care in the 10 counties and parishes in Louisiana andMississippi that have been directly affected by Katrina flooding," saidUNC’s Dr. Thomas C. Ricketts. "Over two-thirds -- 4,486 -- of thosewere in the three central New Orleans parishes that were evacuated."
Thenumber displaced also was more than one-quarter of the total number ofnew physicians who start practice in the United States each year, saidRicketts, deputy director for policy analysis at UNC’s Cecil G. ShepsCenter for Health Services Research and professor of health policy andadministration at the School of Public Health.
"A largeproportion of the practicing physicians in the area were also intraining in residency programs," he said. "In the immediatethree-parish New Orleans area, more than 1,270 residents physicianswere training at the time Katrina struck."
Ricketts, who alsodirects the Southeast Regional Center for Health Workforce Studies, ledthe analysis of data drawn from the March, 2005 American MedicalAssociation Masterfile of Physicians and FEMA-posted information. Healso used data from the American Association of Medical Colleges,Tulane and Louisiana State universities medical schools, the TexasBoard of Medicine and the state of Louisiana.
Of the physiciansin the Katrina flood-affected areas, which included six Louisiana andfour Mississippi counties or parishes, the majority, 2,952, werespecialists with 1,292 in primary care and 272 in obstetrics andgynecology, the researcher found.
The two New Orleans medicalschools at Tulane and LSU enrolled about 1,300 medical students in allyears in 2004, and those students have been moved to other programs inthe region, primarily to Baton Rouge and to east Texas, Ricketts said.Various agencies and organizations coordinated their relocation,including the AAMC, state and regional Area Health Education Centers(AHEC) programs in Texas and Louisiana and the Liaison Committee onGraduate Medical Education.
Another 2,052 physicians in 16Louisian parishes FEMA identified as being severely affected (Level 1Disaster Declaration). That included 144 residents in training as wellas 1,032 specialists, 724 primary care physicians and 140obstetrician-gynecologists. Doctors involved primarily inadministration, research or education were excluded from the total butnot those working for the federal government.
"We don’t know whatthis is going to mean to health care," Ricketts said. "We’ve never hadto deal with something like this before."
He said that not onlydid many practicing physicians lose their practices and income, butpractically all of the health records were destroyed in the communityhealth centers within the poorer neighborhoods of New Orleans.
"Reconstructing those records is really going to be extra difficult," he said.
Rickettssaid one possibly positive result of the disasters could be greatersupport for electronic medical records. Also, some health-careofficials may see the opportunity to reorganize and restructure theirefforts. Some physicians will decide to retire instead of re-openingtheir practices.
"We know from experience that some physicianswill choose to retire, but we don’t know how many," he said. "Likely avery substantial number of physicians will permanently move away fromthe area. This is both an opportunity for places that need physiciansas well as a dire problem for the population that will remain."
Heand colleagues conducted the analysis since they learned from floodingin eastern North Carolina that people would be hungry for informationabout the size of the impact to help them plan for responses, Rickettssaid. The results reveal a very big problem for restructuringhealth-care services since it is difficult to shift or allocate a fewphysicians much less thousands.
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