Sep. 28, 2005
CHAPEL HILL -- Hurricane Katrina and the city-swamping floods that drowned New Orleans and surrounding areas in a toxic gumbo appear to have dislocated up to 5,944 active, patient-care physicians, a new University of North Carolina at Chapel Hill study shows. That is the largest single displacement of doctors in U.S. history, and Hurricane Rita over the weekend will have boosted the total to an unknown degree.
"The nearly 6,000 is the approximate number of physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi that have been directly affected by Katrina flooding," said UNC’s Dr. Thomas C. Ricketts. "Over two-thirds -- 4,486 -- of those were in the three central New Orleans parishes that were evacuated."
The number displaced also was more than one-quarter of the total number of new physicians who start practice in the United States each year, said Ricketts, deputy director for policy analysis at UNC’s Cecil G. Sheps Center for Health Services Research and professor of health policy and administration at the School of Public Health.
"A large proportion of the practicing physicians in the area were also in training in residency programs," he said. "In the immediate three-parish New Orleans area, more than 1,270 residents physicians were training at the time Katrina struck."
Ricketts, who also directs the Southeast Regional Center for Health Workforce Studies, led the analysis of data drawn from the March, 2005 American Medical Association Masterfile of Physicians and FEMA-posted information. He also used data from the American Association of Medical Colleges, Tulane and Louisiana State universities medical schools, the Texas Board of Medicine and the state of Louisiana.
Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, the majority, 2,952, were specialists with 1,292 in primary care and 272 in obstetrics and gynecology, the researcher found.
The two New Orleans medical schools at Tulane and LSU enrolled about 1,300 medical students in all years in 2004, and those students have been moved to other programs in the 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 on Graduate Medical Education.
Another 2,052 physicians in 16 Louisian parishes FEMA identified as being severely affected (Level 1 Disaster Declaration). That included 144 residents in training as well as 1,032 specialists, 724 primary care physicians and 140 obstetrician-gynecologists. Doctors involved primarily in administration, research or education were excluded from the total but not those working for the federal government.
"We don’t know what this is going to mean to health care," Ricketts said. "We’ve never had to deal with something like this before."
He said that not only did many practicing physicians lose their practices and income, but practically all of the health records were destroyed in the community health centers within the poorer neighborhoods of New Orleans.
"Reconstructing those records is really going to be extra difficult," he said.
Ricketts said one possibly positive result of the disasters could be greater support for electronic medical records. Also, some health-care officials may see the opportunity to reorganize and restructure their efforts. Some physicians will decide to retire instead of re-opening their practices.
"We know from experience that some physicians will choose to retire, but we don’t know how many," he said. "Likely a very substantial number of physicians will permanently move away from the area. This is both an opportunity for places that need physicians as well as a dire problem for the population that will remain."
He and colleagues conducted the analysis since they learned from flooding in eastern North Carolina that people would be hungry for information about the size of the impact to help them plan for responses, Ricketts said. The results reveal a very big problem for restructuring health-care services since it is difficult to shift or allocate a few physicians much less thousands.
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