Few Washington physicians locate their practices east of the Anacostia River, doctors say, because the area has a large number of poor patients, many on Medicaid, who have chronic health problems and seem to prefer going to public clinics.
"Like likes like," said Dr. Arthur Hoyte, commissioner of D.C.'s public health department. He said physicians, like other business people, prefer setting up shops in areas where they feel safe, comfortable and among their peers. In addition, he said, most doctors in the city choose to be near the hospitals where they see patients, primarily in Northwest.
"A lot of the satisfaction of being a doctor is making yourself feel that you've helped somebody," Hoyte said, adding that that is not always easy with indigent patients who may be apathetic or who don't follow the instructions their doctors give them.
A recent city study showed that Wards 7 and 8 have far fewer private doctors in practice than do the more affluent sections of the city. For example, in Ward 7, the report said, there are only 22 private doctors, compared with 519 in Ward 2 downtown.
Dr. Clifford R. Booker's experience illustrates the kind of problems that contribute to that pattern. Booker, a pediatrician, had an office in a converted Safeway building on South Capitol Street for three years. He said his practice grew far too busy and, with many of his patients on Medicaid, "I was working harder than I was being compensated for."
In addition, security at his building was a serious problem and after several robberies, he said, he decided he had had enough. He moved his practice out of the neighborhood in 1977, and now has an office near the waterfront in Southwest.
The Physician Manpower Study, prepared for the D.C. State Health Planning and Development Agency, did not try to interpret what the distribution of private physicians means for the residents of the city. At least some doctors who do practice in Wards 7 or 8 believe that opening more private practices in the area would not necessarily improve patient care.
"None of our offices are overcrowded with patients," said Dr. Leroy Jackson, a gynecologist who practices in far Southeast. He said that even when patients are referred to private physicians, they usually go only once or twice before returning to the less formal atmosphere of a clinic.
"Even if you put 3,000 physicians out here, you'd still have the same problem," Jackson said, adding that patients' attitudes towards doctors need to be changed.
Poor people do have greater medical problems, and that "complicates your life as a provider," said James Speight, executive director of the East of the River Health Association in far Southeast Washington. External forces such as poor housing and poor education work against a doctor's treatment regimen, he said.
For these reasons, his federally funded clinic provides a nutritionist, a social worker and transportation to the clinic, as well as a wide range of adult and pediatric medical services. "This adds to the sense that it's a friendly place," said the clinic's medical director, Dr. Eleanor Stewart.
The ambulatory care clinic at D.C. General Hospital offers very similar service and handles more than 100,000 patient visits each year. Both Speight and Dr. Mona Harrison, head of ambulatory care at D.C. General, say it is the variety and familiar atmosphere that keeps patients coming, especially those with limited finances.
"They use the clinics . . . like a supermarket, it's one-stop shopping," Speight said.
"There are generations of patients here," says Harrison.
Maria White prefers taking her 2-year-old daughter Quiana to East of the River because she doesn't receive Medicaid, and can't afford a private doctor. The clinic is more convenient and cheaper, White said Thursday. She said she went to a private doctor herself until he died, then began going to the clinic like her friends. "I didn't want to get used to another doctor," she said.
Other patients waiting for treatment at the clinic's waiting room Thursday echoed White's sentiments. Andre Mosby, an 18-year-old who had come in for allergy treatment, said he has never been to a private doctor. He said he goes to the clinic because that's where everyone else in his family goes.
Many low-income patients depend on Medicaid to pay their doctors' bills. More than half the doctors who have active practices in the city accept Medicaid, but some physicians feel that the large amount of paperwork involved and the low reimbursement rate by the District's Medicaid program also makes practicing in poor areas undesirable.
Jackson said few doctors can survive now on a practice that depends solely on Medicaid patients, and he believes this factor deters many doctors from hanging out their shingles in Southeast.
Internist Everlee Franks stayed in his Southeast practice but stopped accepting Medicaid almost three years ago. He said that while he had no complaints about the reimbursement rate then, the process for recertifying patients each month "put an unreasonable burden on me to determine . . . whether a patient was eligible or not."
Most of the patients Franks sees now either have their bills paid by private medical insurance companies or pay themselves. He also has a sliding fee scale for those who can't afford his prices.
Several doctors point out that many Southeast residents visit doctors in nearby Prince George's County. At the same time, physicians like Robert Dickey, a pediatrician with an office on Good Hope Road SE, say they see inner-city patients as well as patients from the Maryland suburbs.
"I hear all this noise about underserved, but I think it's crazy . . . . That's a figment of someone's imagination," Franks said, adding that he knows of many poor patients using Medicaid who "drive, bus or take a cab over to Georgetown Hospital . . . . Patients will go for medical care wherever they choose to go."