With all the attention on the rising costs of health insurance and health care, another health care crisis may not get as much attention. But experts say it’s almost as significant.

And many who have tried to make an appointment with a primary care physician in the Treasure Valley recently have an idea of its impact.

Southwest Idaho, along with the rest of the country, has a primary care doctor shortage. More new doctors are choosing lucrative specialties over the role of the “first responder” to health care needs —  primary care.

As a result, experts say, health care quality suffers, costs rise and access to care can be limited. And its a problem that could get worse as older doctors retire and the population ages.

“The impact on the consumer is you cannot find a primary care physician if you are new to a community ... there are very few that can see you on short notice, (and) if your doctor is older or retiring, there’s no one to replace him,” Saint Alphonsus Medical Group CEO Michael Patmas said.

Saint Luke’s Health System chief medical officer Gary Krouth estimates that Ada and Canyon counties are about 100 doctors short of where they should be based on population. Idaho has the lowest doctor per population ratio in the United States.

While the Treasure Valley fares much better than the state as a whole, it still lacks the family medicine doctors and internists — both primary care-level physicians — it needs.

Why are primary care physicians so important?

• Primary care doctors are less expensive than specialists because the services they perform are usually less complex and don’t as often involve costly procedures.

• Primary care doctors provide the “front end” of health care, Krouth said. They are usually the first health care provider a person goes to and they can take care of most of the problems for which patients come to them.

• Ideally patients see the same primary care doctor for long periods, which enables those physicians to understand their patients’ health and personal histories. “When you don’t have a primary care physician, you’re losing that concept of a medical home,” Patmas said.

• People without primary care physicians often go to emergency rooms for health care, which is expensive and inefficient because patients don’t see the same physician when they go. “That’s not good primary care to see somebody different every time,” Krouth said.

• With the shortage in primary care, patients sometimes end up going to specialists for primary care services because they can get in more quickly to see a specialist. Health experts say that’s a less-than-ideal way to treat simple health needs such as prescription refills.

The shortage can be worse for older patients. Because Medicare reimbursements for primary care physicians are low and time-consuming, some will not take Medicare patients, making the pool of doctors available for these individuals even smaller. And older people tend to use internal medicine physicians more because they deal with more complex health problems, and internists are in short supply.

“Right now internal medicine is a dying specialty,” Patmas said. “It’s dying on the vine.”

Suzanne Allen is a Boise family medicine physician and assistant dean for the University of Washington’s Northwest region medical school. She tells a story about a woman in Massachusetts who was excited about getting health insurance when her state began subsidizing it. But when the woman tried to get a doctor’s appointment, she was disappointed.

“She was going to have to wait six months to see a physician she would consider her primary care physician,” Allen said. “That is the crisis. Everybody is focused on insurance, but once you have the ability to pay for care, you have to have a doctor who will care for you.”Primary care losing its appealTREASURE VALLEY — The financial bottom line has driven medical students away from primary care practice and toward specialists work over recent decades.

Primary care physicians can make about $150,000 a year. Specialists can make two to three times that much; they are trained longer and perform  procedures which are complicated and costly.

Couple those factors with Idaho’s low reimbursement on Medicare and Medicaid because of its lower cost of living and medical school debt that has bulged to as much as $250,000, and it’s easy to see why fewer doctors are opting for primary care practice. That’s what causes the shortage.

“Over the past couple of decades its become increasingly more clear that primary care is losing its luster,” Saint Alphonsus Medical Group CEO Michael Patmas said. “And it’s because of the increasing pay difference.”

Specialists are valuable and needed, Patmas said. But only 7.3 percent of conventional medical school students go into family medicine, a chief component of primary care, according to a 2007 edition of the Family Medicine Journal. That number cannot keep up with the demand for primary care.

Solutions to the problem are neither simple nor easy. Some experts promote leveling the wage difference between specialists and primary care doctors. But that would involve an overhaul of the system and government regulation.

“For someone to get more, someone else has to get less, and therein lies the rub,” Patmas said. “How do we do this equitably and fairly?”

Government or private subsidies could help pay tuition for aspiring doctors who want to go into primary care. And Medicare’s reimbursement for primary care could be increased.

Gov. Butch Otter recently suggested creating a medical school in Idaho. But that, Patmas said, is  expensive, adding that the money might be spent just as well paying bonuses to doctors who go into primary care.

The solution won’t come quickly because it takes a long time to train doctors, Saint Luke’s Health System chief medical officer Gary Krouth said. And older doctors who went into primary care when its pay was closer to specialty pay and medical school debt was not as high are retiring.

“As they retire, they’re not going to be replaced as quickly, and it will just exacerbate these issues,” Krouth said.