Patients trying to save money are getting sicker before they seek care, family doctors say.
Dr. Glenn Nemec performed a physical exam on a patient Tuesday at the Monticello Clinic. Nemec said about a dozen of his patients have been hospitalized in the last three months as a result of cutting back on doctor visits and prescriptions in order to save money.
More people are canceling doctors' appointments, leaving prescriptions unfilled and skipping screenings such as Pap smears to save money, according to a national survey of family doctors that was released Tuesday.
As a result, more patients are winding up with health problems that could have been prevented, the American Academy of Family Physicians said in its report.
The academy e-mailed more than 8,000 doctors, asking questions about the effects of the recession, and 505 doctors completed the survey in March and April of this year.
Seventy-three percent of doctors who responded said more patients are cutting prescription dosages. Sixty percent said they had seen more health problems caused by patients skipping preventive care and 58 percent reported more canceled appointments.
"The findings are troubling," said Dr. Ted Epperly, the academy's president.
Dr. Glenn Nemec, a family doctor at Monticello Clinic northwest of Minneapolis, said he's seeing the same trends locally.
Nemec sees three to five patients a day who have stopped taking their medication or otherwise reduced care for a chronic condition. Before, it was one a day.
The consequences can be life-threatening. Nemec estimates that about a dozen of his patients have been hospitalized in the last three months as a result. They included diabetics, patients with congestive heart failure, patients with chronic lung disease and one patient hospitalized for a bleeding ulcer after he stopped taking his ulcer prevention medication.
"Everybody said medicine is recession-proof and for the most part, that was the case," Nemec said. But the recent advent of higher copays and deductibles means that, for patients, "money's coming out of their pockets ... a little more directly."
Nemec, who has been practicing for 25 years, said, "This is the worst I've seen it."
As patient visits have dropped, doctors at Nemec's clinic have taken pay cuts. On slow days, they send staff members home early.
Dr. Macaran Baird, head of family medicine at the University of Minnesota, called the survey results "pretty obvious."
He's worried about what it means for pay-for-performance programs. For several years, insurers have paid physicians a bonus for hitting performance goals -- keeping a diabetic's blood sugar under control, for instance -- or withheld pay when goals aren't met.
If patients stay away because of the economy, and subsequently get sicker, doctors will essentially be penalized for something they can't control, Baird said.
Such surveys are useful for highlighting problems but don't offer broad conclusions because "you're asking an opinion," said Dr. Pat Courneya, a family doctor and medical director at HealthPartners.
It's too soon to see the effects of skipping screenings such as colonoscopies and mammograms, if there are any, he said. And according to HealthPartners claim data, diabetes care actually improved in 2008 compared with 2007.
Courneya said he suspects the threat of job loss -- and loss of health insurance -- may actually act as a motivator for some people to stay well.
That said, those who staff the appointment lines at HealthPartners clinics say patients are much more worried about being away from work. They are more likely to ask: "Do I need to come in? Is there another way for me to take care of this?" They're also asking a lot more questions about cost.
As with any industry under pressure, doctors have also been forced to change how they do things, in ways that ultimately benefit patients.
For example, Epperly's clinic has started accepting many more same-day and next-day appointments. Physicians also are boning up on what things cost so they can answer patients' questions.
"It's really enhancing our business knowledge," Epperly said.
Chen May Yee • 612-673-7434