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City suffers from chronic shortage of physicians

Fellowship Story Showcase

City suffers from chronic shortage of physicians

Picture of Mark Taylor
Post-Tribune
Monday, March 14, 2011

Nearly 33 years after the federal government designated Gary a health professional shortage area and 17 years after federal health authorities qualified it as a medically underserved area, Gary continues to suffer from physician shortages.

Those shortages are partially to blame for the poor health status of many Gary citizens, according to local doctors and hospital officials.

Gary is home to disproportionately high numbers of severely ill patients suffering from multiple potentially life threatening conditions, including heart disease, kidney failure, diabetes, hypertension, obesity and asthma.

Race and income account for some of those health care disparities. African-Americans suffer higher rates of those conditions, according to national health surveys and federal agencies like the U.S. Centers for Disease Control and Prevention. And Gary’s declining population — which dipped from 180,000 in the 1970s to less than 85,000 as estimated by the U.S. Census Bureau — is nearly 85 percent black.

According to the Healthcare Resources and Services Administration, the agency that administers funding for federally qualified community health centers, nearly one-quarter of Gary’s population lives below the federal poverty guidelines, with the economic status of more than half its people categorized as low income.

Not enough doctors

At one time the city was home to nearly 100 doctors, but now fewer than 35 have offices in Gary.

But some insist the shortage of physicians and a lack of access to primary care services are rooted in the Steel City’s health troubles.

Many physicians have moved their practices to neighboring communities, fleeing the crime, poverty and perceptions clouding the city’s reputation. Physicians face financial challenges everywhere in the United States, with declining reimbursement rates and increased office expenses and liability insurance costs. Physicians who treat large numbers of poor and uninsured patients and those covered by Indiana Medicaid are hit even harder.

Gary obstetrician Deborah McCullough said the departure of physicians altered the health care landscape in Gary.

“The doctors left and patients tried to follow their physicians outside of the city,” said McCullough, who has practiced in Gary for 32 years. “Transportation is a big problem though. When you have a doctor who moves his office out to 93rd Street in Crown Point and you live at 6th and Adams in Gary, you’re going to have a hard time getting there without a car and you’re going to miss a lot of appointments.

“Many people in Gary think we don’t have any doctors left, so they believe they have to leave the city to get health care. That just isn’t true.”

But those perceptions are difficult to shake. Physicians, hospital and clinic administrators said surveys indicate that between 45 percent and 60 percent of Gary residents leave the city for health care services, whether traveling to neighboring Merrillville or Hobart or trekking to Chicago.

Former Gary Mayor Richard Hatcher said when he came to Gary in the early 1960s the city boasted scores of practicing physicians, most of whom were white, and “an exceedingly low number of African-American doctors.” Hatcher said a black Gary pharmacist named Randall Morgan, whose son is a surgeon, personally launched an effort to recruit more black physicians to serve the growing numbers of blacks living in Gary. Just when those efforts began bearing fruit, the city suffered an exodus of white physicians. Hatcher said decades later that process repeated itself, with black physicians first joining the medical staffs of hospitals in neighboring communities and later starting offices there.

“The number of African-American doctors in the city has declined as well and the number living here has dwindled greatly,” he said.

Climate is improving

Gary cardiologist Vijay Dave knows he could make more money in private practice outside of Gary.

“But I’m a firm believer in this city, even though most of the patients either have Medicaid, which pays lousy, or no insurance,” said Dave, who began practicing in Gary in 1977. “I feel bad to charge someone when they don’t have money. It’s tough. Our Gary office is struggling. Once we were fully occupied. The property taxes are so high in Gary. The cost of doing business is high, and reimbursement keeps going down.”

Dave, former chairman of the Lake County Medical Society, said despite the problems he remains committed to Gary.

“I made my first dollar in Gary, and I want to make my last profitable dollar in Gary as well,” he said.

Gary nephrologist David Ashbach, 68, began practicing in Gary in 1980. Ashbach, who heads Methodist Hospitals’ Performance Improvement Committee and has served as medical staff president, said previous Methodist Hospital administrations alienated many Gary physicians through “blind-sided practices,” such as a money-saving program called voluntary early retirement that cost the hospital many experienced nurses and staff.

Ashbach said Methodist has made progress in recruiting new primary care physicians to Gary. But he said misperceptions remain.

“Enough U.S. Steel employees and retirees with good insurance still live in Gary,” he pointed out. “Overall, the payer mix isn’t that bad. Despite the challenges, Gary is a good place to practice medicine.”

The city’s only hospital, Methodist Hospitals Northlake Campus, is spending money to recruit physicians, said Denise Dillard, the hospital vice president of policy. “Practicing in a medically underserved area like Gary is a good thing for those doctors.” She said their average salary is $170,000 and in some cases the government forgives their medical school tuition and loans.

Gary Public Health Commissioner Ricardo Hood said Gary’s physician exodus has economic roots.

“If your practice has a lot of Medicaid and self-pay, there’s not a lot left when you go to file your taxes,” Hood said. “Many doctors left because if they didn’t, they would have exhausted their resources and had to file for bankruptcy.”

He said for physicians to provide services, they need to be paid and the only sure sources of stable income for new Gary doctors are Methodist Hospitals and Community HealthNet, the Gary federally qualified community health center, both of which employ physicians.

Dr. Janet Seabrook, executive director of Community HealthNet, said the community health center has used Gary’s designation as a medically underserved area and health professional shortage area to recruit physicians and advanced practice nurses from the National Health Service Corps, which offers loan repayment and medical school tuition forgiveness plans in exchange for working in needy areas.

Seabrook said the health center has been the largest recruiter of new doctors to Gary, “Unfortunately, most just do their two years and leave. Two left last year. ... As a provider you know your work is greatly appreciated when patients see you genuinely care about them. But as a person, it takes a toll,” she said.