Primary care physicians in New Jersey are paid at some of the lowest Medicaid rates in the nation, data shows.
Last year, Dr. Montrea Thomas thought she had a few more years left before she would have to retire her pediatric practice in Orange.
But in a couple of weeks, the 78-year-old pediatrician, who mostly cares for low-income children, will close her office because she can no longer pay the bills.
“I am in debt, quite a bit,” Thomas said. “And when I close my practice, that is one of the reasons I’m going to have to close.”
Thomas is paid mostly through Medicaid, a state and federally funded insurance plan that covers low-income patients.
Nationwide, doctors who accept Medicaid are paid much less than private insurers. In New Jersey, data shows Medicaid rates are among the lowest in the country.
As a result, experts say fewer doctors accept Medicaid, which means low-income residents have fewer options for care than their wealthier counterparts.
“There needs to be a better focus on supporting us financially,” Thomas said.
Primary care physicians like Thomas focus on preventative care, such as addressing day-to-day health concerns and conducting annual health checkups. They can be doctors, nurse practitioners, or physician’s assistants.
Research shows that access to primary care decreases illness and death and bridges the gap in health outcomes between Black and brown people and their white counterparts.
New Jersey ranked 48th in the nation for health insurance spending on primary care visits in 2019, including Medicaid, according to a study published by the New Jersey Health Quality Institute last year. This means doctors like Thomas get paid less than they would in other states.
“In New Jersey, we’re facing a crisis on the ground floor of health care,” said Dr.Alfred Tallia, a Department of Family Medicine and Community Health professor at Rutgers Robert Wood Johnson Medical School and one of the study’s authors.
For example, if a doctor treats a patient with a fever in New Jersey, Medicaid will pay $50 for the treatment compared to private insurers, which would pay anywhere from $70 to $110, Tallia said.
These rates disincentive doctors from accepting lower-income patients, he said.
“There are clinicians who, despite the terrible remuneration, will still serve an underserved population, but they’re few and far between, and they’re not enough,” Tallia said. “So as a result, New Jersey has a huge disparities problem.”
Dr. Rosario Zambrano, a pediatrician and owner of Essex Pediatrics in East Orange and Pediatrics of Morristown, has seen this occur firsthand.
Before she opened her practice in Morristown, residents had to drive out of Morris County to find a pediatrician who took Medicaid.
“We realized there was a void here,” Zambrano said. “The immigrant population and the lower-income population that worked part-time at McDonald’s, that cleaned the bank, that did the babysitting would have…nowhere to go in Morris County.”
As Thomas tries to find new doctors for her patients, she’s encountering the same issue.
“We’re finding it difficult to transition our patients to people who are accepting the insurance,” Thomas said, referring to Medicaid. “They may be accepting new patients, but they’re not accepting certain insurances.”
When Thomas started treating patients 50 years ago, she had a full-time pediatrician and a physician’s assistant on staff. She would also train a recently graduated medical student every couple of months. But as she took on more patients insured through Medicaid, she had to make tough decisions to keep her practice afloat.
“My income dropped drastically,” Thomas said. “I let staff go.”
She also said she relied on part-time workers and took in more residents.
“That helped a great deal,” Thomas said.
In her personal life, Thomas said she lived paycheck to paycheck.
“I would have loved to add more income to splurge. I would have loved that,” she said.
Still, Thomas, a pastor’s wife and preacher’s daughter, says the sacrifices were worth it.
“That was my mission from the beginning to give the best of mine, whatever I had, into my community, even though it meant a huge sacrifice in terms of finances,” Thomas said.
She said closing her practice has been painful for her and her patients.
“We are shedding a lot of tears in these next few days and weeks,” she said.
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Amira Sweilem may be reached at asweilem@njadvancemedia.com.