GRAND JUNCTION, Colo. — Jim and Thelma Humphrey say they can’t find a doctor in the Grand Valley who will accept them as new patients.

In June, their physician of 15 years quit medicine, citing massive paperwork as his reason for leaving.

“He said he would take a lot more patients if not for the paperwork,” said Jim, 75.

“He’s an excellent doctor. The sad thing about it is people are not being helped by him now.”

The Humphreys said they’ve contacted at least a dozen doctors who say either they’re not accepting new patients or they’re not taking patients with Medicare or Medicaid insurance. Jim and Thelma, 74, are insured by Medicare and Medicaid.

When Thelma contacted St. Mary’s Family Medicine, she asked if she could be put on a waiting list, but was told “no, that wouldn’t work,” she said.

“I guess if a person really needed something they could go to the emergency room,” Thelma said.

Jim and Thelma are relatively healthy.

They don’t smoke or drink.

They avoid junk foods.

They eat fruits and vegetables.

And they’re well-read and articulate.

But occasionally they need to see a doctor. Thelma has diabetes and high blood pressure for which she takes prescribed medicine.

Her former doctor wrote a prescription that will carry her through March 2009. After that, if she still doesn’t have a doctor, she’ll have to go to the emergency room to get a new prescription.

The Humphreys’ neighbor Doris Tennant has a doctor but she’s worried she won’t be able to find another one when he retires. The 75-year-old widow works four days a week at Ace Hardware to supplement her Social Security income and Medicare insurance.

“It’s a frightening thing to me, people who can’t get a prescription written,” Tennant said. “Some of these medications are life-saving. If you can’t find someone to write a prescription, what are you supposed to do — lay down and die?”

“If I had private insurance there’d be no problem at all,” Tennant said.

When someone needing a doctor calls St. Mary’s referral service, the service will give the caller the names of three physicians who are accepting new patients on a case-by-case basis.

It is up to the doctors’ discretion whether to accept a new patient or not.

Neither the Humphreys nor Tennant blame the doctors.

They say the problem is a Medicare reimbursement rate that is lower than what doctors receive from patients with private insurance. Time-consuming paperwork, and bureaucrats making medical decisions are also part of the problem, they said.

“I think this whole thing came to a head when fat cat politicians said, ‘We’re going to cut Medicare,’” Jim said.

‘It’s a nightmare’

Seniors who do not have private insurance to supplement their Medicare have a tough time finding physicians because doctors are paid very little for taking care of Medicare patients, said Dr. Michael Pramenko, a family practice physician in Grand Junction. By the time a doctor pays his staff, operating expenses, and overhead, there’s little left over, he said.

Pramenko said his practice is full and he has to turn away patients every week.

“We avoided another Medicare reimbursement cut this summer,” Pramenko said.

Congress overrode a presidential veto of a bill that would have prevented another 10 percent cut in Medicare from occurring, Pramenko said.

Cuts in Medicare funding “didn’t start with the Bush Administration, but it certainly got a lot worse,” he said, and that has added to the physician shortage.

Doctors need to be cognizant of the number of Medicare patients they see, or they’d soon be working for nothing, Pramenko said.

The number of medical school students going into primary care is half of what it was 10 years ago.

Specialists can earn more than $300,000, as opposed to a primary care doctor who makes closer to $100,000 to $150,000.

With a $200,000 college education debt, there’s not much incentive to become a primary care physician, Pramenko said.

If doctors only took care of Medicare patients they’d be earning $50,000 to $60,000 a year — not enough to motivate people to be on call, work long hours, and take on the debt of medical school, Pramenko said.

Another problem is the time it takes to be reimbursed for care.

“It’s a nightmare,” Pramenko said. “Some pay in six months. You almost need a business degree in addition to a medical degree to keep your practice going.”

Pramenko serves on the Colorado Medical Society’s Health Care Congress — a group of physicians who has been studying health care reform for the last three years.

“All the facets of our health care system are breaking down,” Pramenko said. “To fix health care we need to emphasize primary care, and provide incentives for physicians to choose that care.”

Causes and possible remedies

Dr. David West, who recently retired as director at St. Mary’s Family Medicine Residency Program, said the program gets 100 requests a week from people seeking a primary care physician. West said there is a huge doctor shortage in Mesa County and on the Western Slope.

West attributed the shortage to several factors:

• Medical schools graduate the same number of doctors now, 17,000 a year, as they did 30 years ago. Yet there are 60 million more Americans, and an older population.

• Most doctors do not work the long hours they did 30 years ago, when 12-hour days were not uncommon. More women are doctors, and both men and women want more time for family and personal life, which has led to unexpected physician shortages.

• Visa requirements make it harder to import doctors. One-third of U.S. doctors are immigrants.

• An ever-growing bureaucracy in health care, declining incomes, insurance company hassles, and malpractice suit threats are causing doctors to leave the profession early.

St. Mary’s Hospital is working with the University of Colorado medical school to address the doctor shortage in Mesa County by working on creating a branch campus in Grand Junction. Here, medical students would spend their last two years of clinical rotation.

In other states where there are branch campuses, students, upon graduation, often return to those communities where they did their clinical rotations, said Dan Prinster, vice president of planning and development at St. Mary’s Hospital.

St. Mary’s is also considering training more family practice doctors by expanding its residency program. Out of 150 physicians who have graduated from the program, 100 have stayed to practice in western Colorado, Prinster said.

Prinster said the doctor shortage is not unique to Mesa County, but is a nationwide problem.

St. Mary’s has also implemented a hospitalist program, where people who do not have a primary care physician and are admitted to the hospital will be assigned a doctor to coordinate their care while in the hospital.

Brussels sprouts and juniper berries

Jim and Thelma can’t go to Marillac Clinic, a clinic for the uninsured, because they have Medicaid and Medicare insurance.

Thelma has had a cough and a cold for weeks. She’s not the type to run to the doctor for every little thing, “I’d just as soon not go to them,” Thelma said, “but there are times ...”

Meanwhile, she’s turning more to natural remedies. She bought juniper berries at a health food store because she heard they help a person with diabetes. And she’s going to start eating brussels sprouts, because she heard those are good also.

Reach Sharon Sullivan at ssullivan@gjfreepress.com.