Saturday, September 8, 2007

To the nursing shortage, add doctors

Most people are familiar with the nursing shortage. But there’s another health care story that deserves our attention – the growing shortage of doctors.

Retiring doctors often are unable to find replacements for themselves, especially when they are in solo practice. Sobering facts: 28% of New York’s doctors are in solo practice, and 34% of the state’s doctors are over age 55[1], meaning their retirement is in the foreseeable future.

Why do retiring doctors have a hard time finding younger physicians to replace them?

For one thing, finding a replacement doctor costs money (advertising, travel, and recruitment firm, not to mention the new doctor’s salary). Many practices operate on tight margins, and money spent on recruitment has to come directly out of the budget for staff salaries, including the doctor’s own.

New doctors often come into practice burdened with high debt from their medical schooling. They need a decent income quickly, and they cannot afford to wait, gradually building their patient base over several years as in the “good old days.”

Another concern, physicians need coverage. New physicians need to join a coverage group immediately – that is, a set of doctors who agree to cover the new doctor’s patients on a scheduled basis after office hours and on weekends. Every physician needs such coverage, and those who fail to get it cannot practice indefinitely with self-coverage. No one can work (or be on call) 24 hours a day, seven days a week.

Some parts of the country – those with booming economies or year-round pleasant weather – have advantages when recruiting doctors, just as they do when recruiting engineers or other professionals. Although Central New York's rolling hills, clear lakes, and four seasons are beautiful, its slow-growth economy does not add to its charm.

“At a time when the aging baby boomer population finds itself in need of more medical services,” reported the New York Times recently, “fewer young doctors want to work in many of the distressed cities and towns throughout New York State.”

Add to these complications, a doctor supply problem. In a recent Post-Standard op-ed article, Dr. David Smith, President of SUNY Upstate Medical University, wrote that “too many of the doctors now in training are not choosing the most needed specialties. Primary care physicians, general surgeons, and obstetricians are in high demand.”

And, according to the Wall Street Journal,

[p]rimary-care doctors, including internists, family physicians, and pediatricians are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005….The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.
Why are fewer doctors going into primary care? Money. The median income of primary care doctors is about 45% below that of specialists, according to the Journal. Remember, doctors have to pay off those medical school loans, which can amount to hundreds of thousands of dollars.

Last year's report by the Center for Health Workforce Studies shows the supply of primary care doctors in Central New York at 64.4 per 100,000 population. That compares with 76.0 per 100,000, the median ratio among all regions of the state. The report also shows that CNY’s physician supply lags other regions in such specialties as pediatricians, neurologists, infectious disease, psychiatry, and others. Although CNY has 2.7 endocrinologists per 100,000 population (which is slightly better than the 2.2 median for all state regions), a recent story reported that several endocrinologists are leaving Syracuse.

If the nursing shortage is a major problem, the doctor shortage is not far behind.

[1] Armstrong DP and Forte GJ. Annual New York Physician Workforce Profile, 2006 Edition. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany. December 2006.

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