More residencies said to be vital to keep doctors

UCF’s Dr. Deborah German and others endorse legislation to increase such positions.

Harry Wessel | Sentinel Staff Writer
http://www.orlandosentinel.com

When the University of Central Florida won approval last year to build a medical school, the landmark event was touted as a key step in alleviating both the region’s and the state’s growing shortage of physicians.

But while the training starts with medical school, it must continue with a residency program in which the budding physician learns on the job. Which is why Dr. Deborah German and every other medical-school dean in Florida endorsed federal legislation Tuesday that would expand residency programs here and in 23 other states that face critical shortages of medical-residency slots.

“You have to increase both to increase the number of physicians,” said German, dean of UCF’s medical school, which is scheduled to open in the fall of 2009.

The endorsement was a “no-brainer,” German said. While the number of Florida medical-school graduates is expected to double during the next 10 years, there are currently no plans to substantially increase the number of medical residencies.

The Resident Physician Shortage Reduction Act, introduced last month by U.S. Sen. Bill Nelson of Florida and Senate Majority Leader Harry Reid of Nevada, would provide 347 new residency slots in Florida, 93 in Nevada and a total of 1,222 nationwide.

While the Senate version has yet to attract bipartisan support, the House version has drawn a number of Republican co-sponsors, including Florida’s Ric Keller, Dave Weldon, Ginny Brown-Waite, Jeff Miller and Mario Diaz-Balart.

It also has attracted support from influential organizations, including the American Medical Association, the American Osteopathic Association, the Florida Academy of Family Physicians and the Florida Hospital Association.

Dr. Jay Falk, chief academic officer for Orlando Regional Healthcare, said the legislation was sorely needed, particularly in Central Florida.

“The whole notion that the building of a medical school in Central Florida is going to increase physician manpower without the addition of residency slots is a pipe dream,” said Falk, who oversees nearly 200 trainees in residency and fellowship programs at Orlando Regional.

He cited numerous studies showing that doctors usually wind up practicing where they complete their residencies, rather than where they go to medical school.

Falk was seconded by Dr. Michael Muszynski, dean of the Orlando campus of Florida State’s college of medicine. Doctors are twice as likely to settle in the state where they did their residency as they are in the state where they went to medical school, he said.

“There would not be a medical school anywhere that is not in favor of this bill,” Muszynski said. “All of us have a shortage of where to send our medical students. The country as a whole is way behind in the funding of residency positions in general.”

Residencies are expensive. The direct and indirect cost of a single one runs about $186,000, according to data gathered by the Florida Legislature’s Graduate Medical Education Committee. The committee also had some encouraging news: The state gets some bang for its residency buck. As many as three of every four physicians who complete their residencies in Florida stay in the state.

While Florida ranks 46th among the states in the number of residencies in relation to its population, it ranks fourth in retaining physicians after their residencies.

Whether federal legislation will be enacted to help Florida expand its medical residencies remains an open question, but Orlando Regional’s Falk is encouraged.

“Congress is now aware of the fact you need to have a graduate medical-education piece in concert with new medical schools and medical-school expansions. Otherwise, you’re just shuffling the deck.”
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