Thursday September 24, 2009

Oswego County Has Shortage of Cardiologists

By Aaron Gifford

There's no shortage of board-certified cardiologists in Syracuse, but just outside of the metropolitan area, those specialists are few and far between.

In Oswego County, there are two. Further north, many miles separate cardiology offices between Watertown, Massena, Canada and the Vermont border.

This is a regional reflection of a national shortage, says David Gorra, chief operating officer of the New York Heart Center. 

“Many doctors prefer not to live up there,” said Gorra, who oversees New York Heart Center offices in Onondaga, Oswego, Cayuga and Jefferson counties. “When there's a shortage nationally, why would you want to live in Gouverneur when you can live in Atlanta?”

There are more than 30 board certified cardiologists in the greater Syracuse area, including 10 at the New York Heart Center. Gorra estimates that more than a quarter of them are over 50 years old. And he believes that fewer medical students are leaning toward cardiology these days, partially because other specialties are less demanding and allow for shorter work days. 

Gorra said a proposed national health care plan compounds the problem. Medicare reimbursement for cardiologists would be slashed drastically under the plan, he said, and that would drive insurance companies to follow suit; 50 percent of cardiology patients rely on Medicaid or Medicare, and most patients are over 65.

“Many cuts are already proposed for next year, without a national health care plan. If those cuts go through, that'll put an even greater strain on cardiology practices locally and across the country. Offices could close, services and staff could be cut. Some of the doctors who are over 55 could retire sooner than they thought,” Gorra said. “They'll be more competition, nationwide, for existing cardiologists.”

And yet, the need for cardiologists, Gorra said, is growing. An aging population in rural Upstate New York struggles with obesity, poor diets, smoking-related illnesses and a lack of preventative health care. “Preventative medicine is not common (in some rural counties),” Gorra said. “For a lot of people, something has to happen first before they go to the doctor.”

The American College of Cardiology reported that there are currently 3,000 too few heart doctors in this country, and that the shortfall could amount to 16,000 needed cardiologists by 2050. That agency attributes the shortage to fewer cardiology slots in medical schools spurred by increasing managed care practices and “an assumption that family practitioners would be able to provide much of the care for

heart disease patients.”

Dr. Perry Pugno, medical education director for the American Academy of Family Physicians, located in Kansas City, said family physicians in the past two decades have indeed been trusted to handle heart- related ailments like high blood pressure and minor congestive heart failure.

Problems like diabetes, severe obesity and hypertension affect other parts of the body in some cases or are a part of a larger problem “that shouldn't be treated in isolation,” he said.

“If you've got three or four doctors treating each thing independently, the treatment themselves might cause new problems, such as adverse reactions to medication,” Pugno said. “You want your specialists to tend to the really sick people.”

Moses Kyobe, one of the two board certified cardiologists in Oswego County, says his New York Heart Center office in the city of Oswego currently has 4,000-5,000 active patients, including one who travels more than 100 miles from Gouverneur, St. Lawrence County.

To keep up with the huge caseload, Kyobe said he typically leaves his house at 5:30 a.m. each morning to make rounds at Oswego Hospital before his office opens. He said he usually finishes his work day around 9 p.m.

“For the most part, it's like this every day,” said Kyobe, who has three young children.

Kyobe, a native of Uganda, took a position with the New York Heart Center in Oswego County as part of a visa/immigration program run by the state and federal governments to help provide physicians to underserved areas. He arrived there six years ago and fulfilled his three-year obligation, and decided to stay in Oswego.

However, he said, “I don't think I can maintain this work for more than five more years without help.”

Kyobe thinks Oswego County's harsh winters and its relatively larger proportion of indigent residents (compared to surrounding communities), coupled with looming Medicare cuts, might be discouraging factors for young cardiologists looking for a place to practice.

Representatives from the Oswego Hospital and the Oswego County Medical Society said they weren't aware of a cardiology shortage in their area, although they did note that many local patients visit Syracuse specialists, and that others might just see a local internist for heart-related services.

Kyobe said he is on call at Oswego Hospital “every day when I am in town.” The other cardiologist in Oswego County, Jayakumar Thotambilu, of Fulton, declined to be interviewed for this story. 

Heart disease is the top killer of men and women in the United States. In 2006, there were more than 80 million cases of cardiovascular diseases in this county, according to the American Heart Association.