MediCal patients desperately seeking doctors

Dr. Roy Bishop is one of many Chico doctors who regret what economic forces have driven them to do: refuse to take any more patients on MediCal, the federally funded, state-managed health insurance system for low-income people.

Because government reimbursement rates don’t cover the full cost of treating those with MediCal, including those with a Medicare-MediCal combination, physicians have been picking up the difference. “Providers are getting squeezed,” said Bishop, who started Argyll Medical Group in summer 2001 in anticipation of a changing health care system. “You basically operate at 20 percent below cost, and we can’t afford to do that. It’s unfortunate we have to discriminate, [but] payroll is still due every two weeks.”

Patients who have MediCal, or even Medicare plus MediCal, are “having to scrounge around for a physician who will accept both,” said Tatiana Fassieux, the program manager for the Health Insurance Counseling & Advocacy Program (HICAP) at Passages Adult Resources. More likely, they’ll visit clinics and get less personalized service.

A study released last month by the Centers for Studying Health System Change ( found that, from 1997 to 2001, the percentage of physicians treating MediCal patients went from 87.1 percent to 85.4 percent.

Fassieux believes that decline is mirrored in Butte County. The study, she said, “brings to light the urgency and criticality of physician access.”

Since the last HMO pulled out of town, the options are even fewer. But Fassieux is most worried about elderly or disabled patients, who may not be able to advocate for themselves. She’s heard of people having to wait three months for an appointment. In Paradise, she said, no doctors whatsoever are taking new patients with both Medicare and MediCal. “That adds another layer of anxiety, especially for the elderly,” she said.

Fassieux said some doctors are forgoing potential profits and keeping on current patients who become eligible for MediCal, but she’s not sure how long that will continue. As more people lose their jobs, and as the population ages, more people will be on Medicare and MediCal. She hopes Chico city leaders will consider controlling development before the population grows to the point where the health care infrastructure can’t support it. (There’s a shortage of primary-care physicians here, and there’s also no one to compete with Enloe Medical Center for quality and access.) HICAP gets calls from people considering moving here who want to know ahead of time what their access to health care will be like.

Fassieux said, “It’s going to get worse.”

HICAP is gathering stories from Medicare and MediCal users—particularly about appointment delays or difficulty in finding a physician—and will forward the information to the federal agency that oversees the systems.

Bishop, who is not booting current patients who have become eligible for MediCal, said a 10-percent cut to the MediCal rate implemented Jan. 1 by Gov. Gray Davis is another step backward.

Before the nation makes decisions for the better, Bishop said, the middle class will have to be priced out of health care. Bishop has been lobbying Rep. Wally Herger, R-Marysville, who indicated he’ll work on fixing the reimbursement formula through his role on the Ways and Means Committee.

Bishop said the image of the "rich doctor" is not the case these days, since they’re earning less and carrying more education debt. "Medical school recruitment has fallen off by nearly 40 percent since the peak enrollment in 1996, and it is increasingly hard to attract physicians to semi-rural areas like Butte County," Bishop said, predicting that, if the community doesn’t do something about it, the physician force will continue to evaporate as older doctors retire.