Not Enough Primary Care Doctors in Poor Neighborhoods: Report

Hundreds of thousands of uninsured New Yorkers may get health coverage in the coming years, as federal health care reform takes effect. But city health officials are concerned there might not be enough doctors, nurses, clinics and private practices to see the newly insured.

A new report surveyed the landscape before the Affordable Care Act and found wide disparities in the supply of primary care providers.

“If people are living in low-income neighborhoods, there are not enough primary care physicians around,” Health Commission Dr. Thomas Farley said. “So a lot of people don’t get the primary, preventive care they need.”

The study suggests it’s a very local problem: the city has twice as many primary care providers, overall, as federal authorities recommend, but some neighborhoods lag far behind. The city’s least covered neighborhood, in the North Bronx, has 34 primary care providers per 100,000 people, compared to a national recommendation that a community have 50. The most-covered neighborhood, the Upper East Side, has 261 providers per 100,000.

(Graphic: Full-time equivalent primary care physicians by United Hopsital Fund Neighborhood, NYC, 2009.)

Massachusetts, which implemented its own healthcare reform under Governor Mitt Romney, has reported physician shortages sometimes leading to longer waits for doctors' appointments. The state has 95 percent of its population insured, more than any other state.

Farley said local communities should brace for the mix of good and bad news, when and if broader coverage comes to New York.

Peter Cunningham, from the Center for Studying Health System Change, says that there may be less to the disparity laid out by the Health Department than meets the eye, because unlike some rural and suburban areas, New York City has good public transportation.

Much, he said, depends on the number of community clinics, where low-income people frequently receive care, and on the proportion of medical practices willing to accept Medicaid. Neither aspect is addressed by the city’s report.