Disappearing doctors

By Scott E. Maizel
http://www.baltimoresun.com

Competition: We hear a lot about it in Maryland. The recent debate in Annapolis regarding slots was partly about competing with neighboring states for Maryland’s gambling dollars. Our ports compete with neighboring states for freight and cruise line business. Educational institutions compete with one another for the best students. Athletic teams compete on the playing field during the season and for talented personnel in the off-season.

But a different kind of competition, one with consequences for all Marylanders, has been playing out with little notice. For the last five years at least, Maryland has been losing in the national competition to attract new doctors and retain the ones already here. The reasons for this growing problem will be detailed today at the University of Maryland Medical School, when the results of a comprehensive study of Maryland’s physician work force, sponsored by the state medical society and the Maryland Hospital Association, will be presented to the public.

For decades, about 17,500 new doctors have graduated from American medical schools each year, though our population has steadily grown. Additionally, new doctors are less likely to practice in specialties demanding more of their “free” time, such as primary care and surgery. And this is at a time when there are increasing numbers of older patients, many with more complex medical problems.

Maryland’s doctors are also getting older: The study found that more than 30 percent of the state’s general and thoracic surgeons are likely to retire in the next seven years. The result: Maryland has significantly fewer practicing doctors per 100,000 citizens than the average for the country, and the shortages will soon reach crisis proportions in many regions of the state.

In past decades, Maryland has been able to replace many of its aging primary care doctors with newly trained ones from the various residency programs in the state. But this number has fallen to less than half of what it was just five years ago. For general surgeons, the number produced in Maryland has always been very small: just 16 per year, with no more than three per year staying in Maryland. Now the number of general surgeons who stay in Maryland, practice in the community and respond to patients in our emergency rooms is dwindling.

But the problems extend far beyond our ability to train new doctors. New and experienced doctors already here are increasingly leaving. They are going not just to neighboring states but also to the Midwest, the South and the West.

The reasons for this exodus are familiar. While “lifestyle” is increasingly paramount in a young doctor’s choice of medical specialty, where a doctor chooses to practice is largely determined by financial considerations. Data from a recent Government Accountability Office study of the country’s 319 major metropolitan areas showed that reimbursement for Baltimore-area physicians is the lowest in the country. Private insurers pay doctors in Maryland an average of 5 percent to 20 percent less than is typical in other states. This is at a time when new doctors completing training enter practice with educational debts averaging more than $110,000.

In addition to all the familiar costs – rent, personnel, supplies, etc. – doctors in Maryland have been hit with skyrocketing malpractice insurance rates. Though stabilized at historically high levels by a subsidy program, rates will soon climb again if nothing is changed in Annapolis. Unlike other businessmen, physicians are prohibited by law and contract from collecting additional fees from patients to cover these escalating costs of doing business.

The consequences of our shrinking physician work force are increasingly obvious: longer waits in our emergency rooms, greater difficulty finding a doctor who accepts new patients, fragmented care with more tests, and more expensive health care.

The task force reports include many recommendations to address this life-threatening situation. Among them are measures to attract to Maryland more graduating doctors as they finish their training, to require that more of our health care premiums be used for physician payments, and to improve our malpractice liability climate so that truly injured patients are more quickly and justly compensated. A cap on noneconomic damages, for example, has worked in other states.

When the General Assembly convenes this month, lawmakers should make this issue their first priority. Their goal must be ensuring access to quality, affordable health care.

Expanding health care coverage to more Marylanders is of little value if there are fewer and fewer physicians available to provide the care.

Dr. Scott E. Maizel is president of the Maryland State Surgical Association and a member of the Steering Committee on the Physician Workforce Study for the Governor’s Task Force on Physician Access and Reimbursement.

Editor’s Note: This article originally appeared on the Baltimore Sun’s website. It has been moved or deleted, but we will keep it on our site for archiving purposes.