The Arizona Medical Association has a new leader, and he comes from a part of the state that he says has a lot of health care needs. Dr. Nadeem Kazi is a gastroenterologist who’s been practicing in Casa Grande for the last 27 years. He says he came to the Pinal County city in 1997 for a year — which then became more than two decades.
He joined The Show to talk more about his time in Pinal County.
Full conversation
DR. NAZEEM KAZI: The need for physician in that area, not only physician patients also have a different set of the requirement is different and the state has to hear about the rural areas requirement and that's how I start working with Aero Medical Association for 20 years in different capacity, different positions leading to the presidency of Aero Association.
MARK BRODIE: So in your mind, then what are the biggest needs of, of rural communities when it comes to, to medicine and health care in Arizona?
KAZI: The major issue that we are feeling right now is the lack of physicians, lack of nursing staff, lack of paramedical staff. That's a huge issue that we are facing. And it's not only in Arizona, throughout the country. And some people come with suggestion of a medical student, give them a license and start practicing medicine. The answer to is not improper care, there is no difference between improper care and the no care because improper care leads to more problems.
So what we are suggesting and this year I'm working on and the governor also believe in this thing that we have to increase graduate medical education. So that is very important to increase the supply of physicians. And also the same thing with nurses. And until we have manpower, it's going to be very difficult to take care of health care of this state. This is one of the problems.
Second issue is psychiatry. I mean, we don't have good psychiatry services available in Arizona. And this is also a phenomena throughout the country and we are working on it to see how we can gap, you know, this huge gap because if your mental health is not good, it's very difficult to take care of the physical health. They go hand in hand. So this is another area that we are looking into how to attract people into those fields.
The main issue is the payment for the physicians. I mean, in the last 20 years, 27 years since I've been practicing, there are so many cuts I have never seen any time increasing in my fields, but the costs increasing. So majority of the private practice groups which used to run their offices, they are leaving and they are joining big corporations and the corporations, they don't see the whole aspect of medicine. They just see how to save money here and how to provide care to more people with little you know, availability.
So that's not going to work. It's going to fail in the next 5-6 years. That's, that's another issue that we are facing. So we have to make private practices viable and how to do it. Obviously, you have to attract people. We have to give money to them so they can sustain their practices. I'm at the world, I'm a solo practitioner.
I'm at the worst to walk out now because since COVID, everything is double, whatever we buy is double, the salaries are almost 30% up and my income is, you know, the reimbursement from insurance and Medicare and Medicaid just went down. So I cannot sustain. After the next 2-3 months, I have to make a hard decision to join a hospital or do some corporation because I cannot sustain.
BRODIE: So the challenges that you mentioned are challenges that I think much of Arizona is facing. I wonder if it's maybe more acute in rural areas or maybe it's just a little bit different in a place like Casa Grande than it might be in a place like Phoenix or Tucson
KAZI: Much acute in a rural area, not only Casa Grande or rural areas, there is no specialist, there is no physicians. They are seen by second level providers, and they need a specialist to see. There is no specialist and they have to wait months to get to the specialist. By the time things have changed too much. But yes, it is very acute in rural area. We need to address that issue as soon as possible. And obviously we have to give incentives to these physicians to get to those areas. Not only physicians, also nurses.
BRODIE: Right? I mean, other, other providers, right. That's, that's what it sounds like you're saying. Well, I wonder then if there may be need to be structural changes in how physicians are trained and maybe recruited to the state. You mentioned more graduate medical education, more residency programs, fellowships, things like that. If this is a problem that the entire state is dealing with, but it's much worse in rural areas, what needs to change to make sure that as maybe more graduate medical education programs come online that those physicians don't all just stay in the Valley or in Tucson?
KAZI: As I just mentioned, incentives like they have to get extra pay for sacrificing city life. They have to because there's no ifs and buts about it, if you pay them well, they will stay longer and also give them incentives that they will get, you know, each medical student who comes out right now is anywhere from 400 to $500,000 loan on them. Give incentive there to take half of the loan or full loan. If you serve this area for 10 years or five years, whatever number they pick up and those kind of incentive is needed. I mean, without incentive, you cannot expect people to just go there and stay there. So we have to look into those incentives and how to bring people in.
BRODIE: Do you get the sense that state leaders, political leaders and policymakers understand this challenge and are willing and able to do some of these things.
KAZI: My blunt answer is no. I don't think they don't care but they don't because there are so many other issues they have to fix the budget. I mean, this year we have a huge budget deficit so they are fighting on those issues. So they don't look at the bigger picture.
So we have to change the mindset of our leaders in the House and Senate and also the governor has to work with them and see how to address this issue in long-term fashion, not just acute. So we have to change this mindset. So and we are working on it. It is a medical, is very active in educating the politicians about these issues and how to handle it. And we have committees and we have physicians who's trying to educate them. That's our responsibility. And I think a fiduciary duty also.
BRODIE: Do you think the fact that you are from one of these rural communities will help in that effort that, you know, you can sort of bring this firsthand personal experience and knowledge to lawmakers and the governor?
KAZI: That's what my whole year is going to be working on these rural area issues and that's what we are heading towards. Obviously, I have experience for the last 27 years, all my colleagues, what they experience over there, what they feel, I can express this thing to the leaders in the House and Senate.
