Flagler County has about one-third of the state average of physicians per 100,000 residents.
In a 2011 Community Health Assessment conducted with the Flagler County Health Department, Florida tallied 300.6 doctors per 100,000 residents. Flagler County, however, recorded less than one-third that number, coming in at 93.5 doctors per 100,000 residents.
To County Health Administrator Patrick Johnson, though, that statistic doesn’t tell the whole story of local health care.
The data only accounts for doctors whose primary office is in Flagler, he said. Although the county has no maternity program, for instance, the health department still handles about half of residents’ pre-birth care, he said, thanks to out-of-county obstetricians who work in Flagler a few times weekly. And, as of 2009, 80.1% of all expecting mothers still received early prenatal care (during the first trimester).
But the gap between county and state physicians is widening.
From 2006 to 2010, Florida physicians per 100,000 residents increased 12.4%. In the same time frame, Flagler County increased its ratio by just 7.3%.
“If you look at a lot of data surrounding that number,” Johnson said, “17% of adults have no health insurance.”
That’s 17% of the population that might not be getting any medical treatment. If that number decreased, Johnson suggested, the number of doctors should increase to match the higher demand.
Johnson is also currently working on a grant application for a federally qualified health center, proposals for which should be accepted by the state in November. If funding is granted, Flagler could have a new health clinic, which would bring in new doctors and accept Medicaid, by mid-2013.
Florida Hospital Flagler Communications Manager Lindsay Rew added that the hospital is planning to hire a neurologist and an ear, nose and throat specialist this year, as well, at the new offices in Cobblestone Village.
“There are obviously gaps and pockets of need,” Johnson said. “(But the state) wants to see long-term exploration and a unique model … that they’d be able to invest in.”
David Ottati, Florida Hospital Flagler president, sees more variables in the equation, as well.
“How many cardio-thoracic surgeons do we need in Flagler?” he asked, rhetorically. “Maybe one. However, our community isn’t large enough to have an open-heart program, so even though we may need one doctor, the community isn’t large enough to house the program. So, in essence, we are not large enough to recruit the one doctor that a market survey may indicate we need.”
Ottati conducts in-depth analyses by specialty, he says, using national comparisons to determine where the hospital should grow.
“In my field, Palm Coast has right around the right number (of doctors),” said Dr. Richard Cashio, who is a Palm Coast resident and has an office at Florida Hospital Flagler. He has been the county’s only plastic surgeon for the past five years. “Per plastic surgeon, it’s supposed to be about one per 75,000 residents.”
The low number of overall local physicians comes as a surprise to Cashio. Still, he said, “I don’t think (the low number) has had a negative impact on patient care at all. … With that stat, you’d anticipate difficulty to see a patient. That’s not the case with me or my colleagues.”
Cashio said his patient load has increased each of the past five years; he’s now twice as busy as he was when he started his practice here.
He said some residents might leave Flagler County to see doctors with whom they’ve developed relationships before other doctors moved to town.
In late 2010, the Health and Planning Council of Northeast Florida conducted several focus group sessions on the local medical industry. A few of the common themes are as follows:
“There are good primary-care providers … (but) a lack of specialists.”
“The number of Medicaid providers is very limited.”
“Transportation is a barrier … (and) without insurance, one cannot access the ‘good’ doctors.”
And: “Up-front costs are too high.”
Most participants also stated that they were not satisfied with Flagler’s health system and that it “needs to be fixed.”
Still, the availability of local doctors was not the primary thing most said they require in order to stay healthy — employment was.
A survey of 723 residents showed that 48% believe the most important feature of a healthy community is a healthy economy, and 47% believe access to health care is most important. About 43% rated Flagler’s health care as “Excellent” or “Good,” while 53% rated it as “Fair” or “Poor.”
To Economic Opportunity Advisory Council Chairwoman Barbara Revels, who also serves on the Florida Hospital Flagler board, Flagler’s low doctor numbers are partially a matter of the market not having yet caught up to the population boom.
But it’s more than that.
Many new doctors, because of the high cost of launching a startup, seek existing practices with which to partner, she said. And in a lot of cases, they partner with a hospital which might offer office space or help build their business model.
So, fewer hospital programs mean fewer opportunities for new doctors to become established.
“(But) I’m really surprised by that stat, though,” she added, “because I do think that people can find services when they’re setting an appointment.”
Although Revels believes that many residents do go out of the county for services — like pediatrics and maternity — she also sees a problem of local perception.
“We have great oncologists, a full cancer center,” she said. “For many services we actually do offer here … the hope would be that people would not leave due to reputation.”
But economically, for Revels, small numbers of doctors mean big growth opportunities.
“We know that growing organically, growing from within, is the easiest way to go, the easiest way to create jobs, with the least risk,” she said. More doctors mean more support positions, more medical suppliers, etc.
“It all has a ripple effect,” she said.
Adding that health care remains the largest private employment field in the county, Revels sees the industry as one of her job council’s main focus areas.
“We’re very intrigued about the fact that many medicines these days can be made from plant-based products,” Revels said, adding that marine life is also being tested by organizations such as Whitney Labs. “We’d love to create a medical culture in a little niche market around Flagler County … (but) somebody has got to come up with the compound or the invention first.”
She added: “Everybody’s poised to watch the medical community grow. It definitely will be an economic driver for us.”
To Patrick Johnson, building the industry and increasing services are inextricably tied.
“Health and wealth go together,” he said, explaining why he expects Flagler’s health rating to fall again this year. Two years ago, Flagler was ranked 13th in the state for health care. Last year, it was 17th. And since the rating takes into account factors like unemployment, Johnson expects another dip in 2012.
The new ranking will be released April 3.
THE HEALTH OF HEALTHCARE
The U.S. Supreme Court debated President Barack Obama’s health care reform plan for three days this week. Twenty-six states have filed suit in opposition of a proposal requiring all individuals to have insurance coverage.
As of 2009, Flagler had a higher proportion of residents with insurance coverage (83%) than that of Florida (79%), but it was still lower than the nation (84.9%). An estimated 2,882 Flagler children and 11,969 adults under 65 are estimated to be without health insurance. Most Flagler medical offices do not accept Medicaid.
Although Flagler has remained below the state average in Medicaid residents, its number has risen from 8,404 in 2006 to 12,056 in 2009. The gap between county and state has shrunk, as well, with the state averaging 11,859 Medicaid residents in 2006, and 14,233 in 2009.
Medicaid is also the primary funding source for nursing-home care, paying for about two-thirds of all day-stays and long-term care. In 2010, Flagler averaged 8.8 nursing-home beds per 1,000 residents 65 and older, as compared to the state’s average of 24.9.
US AND THEM
The numbers of specialized physicians in Flagler compared to that of the state, per 100,000 residents, are as follows:
Family practitioners 12.6 19.0
Internal medicine 9.5 41.8
OB/GYN 3.2 7.9
Pediatrics 0.0 14.9
Source: 2011 Community Health Assessment
— Brian McMillan contributed to this report.