Joy Troyer’s been seeing Dr. Max Mertz since she was 14 years old.
The Goshen doctor delivered Troyer’s two children and has treated her entire family for as long as she can remember.
But that kind of relationship with a family doctor is one people in Elkhart County and around the state don’t have, according to a 2012 report from the Indiana Center for Health Workforce Studies.
According to the report, Indiana has just half the primary care clinicians (defined as physicians, physicians’ assistants or nurse practitioners) needed for the state’s population, and a third of those clinicians are nearing retirement age.
'It is getting worse’
Family care providers in Elkhart County are well aware that their ranks are thin.
“It’s been an issue for a lot of years, actually,” Dr. Larry Allen, chief medical officer at IU Health Goshen said. “This isn't a new problem, but it is getting worse.”
Allen worked in family care for 20 years in Syracuse before coming to IU Health Goshen, and he remembers the doctor shortage was an issue then, too.
It’s getting worse because medical students are choosing specialty care over primary care, he said, estimating fewer than 10 percent of IU medical students are going into family practice.
The shortage of family doctors means the doctors Elkhart County does have aren't are taking new patients, he added — and that’s a crisis.
Higher pay, more respect
Local doctors say few medical students are going into primary care because working in specialty medicine carries more respect and more money.
“In academic medical training, there is sometimes a bias toward specialty care,” Allen said. “That’s where the glamour is, so to speak. Students don’t really get exposed to the glory of primary care while they are training, so they don’t choose it.”
Dr. James Nelson Gingerich, who’s worked as a family doctor for 25 years at Maple City Health Care Center in Goshen, said the medical industry has placed an emphasis on specialized medicine over primary care.
“We are giving our medical students the impression that the best and the brightest go to specialty care,” he said. “That’s where the reimbursement was and where the respect was.”
Dr. Mertz, family doctor for 29 years at IU Health Goshen Physicians Family Medicine, estimated doctors in specialty care could make between two and four times the salary of a family doctor.
To a medical student who might have plenty of debt, the higher paying career could look pretty enticing, he said.
Why it matters
Doctors say it’s important for patients to be treated by physicians who know them well and are familiar with their medical history and their families.
If patients do need specialty care, their family doctor can recommend a specialist and advocate for them as they go to a specialist, Dr. Mertz said.
“The relationships you build over time is a unique experience of primary care,” Dr. Allen said. “We used to say from womb to tomb. Small communities really need and trust their doctors. And that’s a privilege, to be able to serve your community in that way.”
What will fix the problem
Dr. Gingerich said it’s important for medical programs to recruit students interested in family care.
If pay for primary care was more equitable, that could help fix the problem, too, he said.
But he and other local health care providers agree family care brings a different kind of reward, one that’s not connected as much to a paycheck.
“I wouldn't want to do anything else, regardless of what I got paid,” Gingerich said. “There is a wonderful relationship-based model for primary care that is gratifying.”