A shortage of primary care doctors is predicted

By Natasha Lee
http://www.stamfordadvocate.com

The supply of primary care physicians is not keeping up with demand, which could be the start of a serious shortage, doctors and health advocates say.

The gap is caused by retirements, better working hours and increased interest in specialty fields such as radiology and dermatology that offer higher salaries, health officials say.

The Council on Graduate Medical Education projects an 85,000 physician shortfall in the United States by 2020.

In Connecticut, medical students and seasoned doctors cite the cost of living and expensive malpractice insurance as reasons to practice medicine outside the state or to leave it altogether.

But as doctors from the baby boom generation retire their stethoscopes earlier and medical students choose specialty disciplines over internal medicine, the patient load is steadily increasing.

“It is just beginning to be practically felt. I think we all agree we’d like to have more primary care physicians in our market than we have,” said Eric Mazur, chairman of the department of medicine at Norwalk Hospital.

Health officials say the state lacks research on the shortage and say information collected by the state Department of Public Health on physicians is poor.

In November, members of Gov. M. Jodi Rell’s Hospital System Strategic Task Force encouraged state officials to start examining ways to address the shortage.

In the past two decades, there has been a shift toward medical school specialties that offer a balance between professional and personal lives, particularly as more women enter the field, Mazur said.

“Students are as concerned with lifestyles and hours as they are with income,” he said.

Graduates have living expenses, earning potential and $100,000 in medical school debt to consider when choosing a discipline.

Primary care physicians who must be available around-the-clock will earn $100,000 to $180,000, compared with a radiologist who can earn $500,000 while working more stable hours, Mazur said.

Low Medicare reimbursement and high overhead costs are cited for driving out private practice physicians. Overhead costs in Fairfield County average 10 percent higher than in surrounding areas, Mazur said.

Poor reimbursement coupled with malpractice insurance in Connecticut, which can run $150,000 per year, make it difficult for physicians to stay afloat. Many team with hospitals to help offset costs. Norwalk and Stamford hospitals own a number of private practices, officials say.

Others say doctors aren’t geographically dispersed. Rural areas may lack access to primary care physicians or specialists.

“There are parts of Connecticut where it is fairly easy to see a physician, and other parts where they are fewer and it becomes much harder,” said Dr. Bruce Koeppen, dean for academic affairs for the University of Connecticut’s School of Medicine.

Hospitals aggressively recruit physicians, particularly those finishing medical school in the state and looking to complete residencies.

“The cost of living has probably been the single largest issue regarding physician recruitment and nursing recruitment,” said John Rodis, chief medical officer for Stamford Hospital. “If you can get close to the same amount of money somewhere else, you end up with a lot more disposable income.”

Replacing physicians lost through retirements or relocations is difficult. New doctors often want to work less hours so it requires more manpower to replace a physician. Rodis said an average of 1.4 to two physicians is needed to replace an existing practitioner.

Retaining graduates is equally difficult.

According to Koeppen, 30 percent to 35 percent of UConn graduates stay in state to practice. Students tend to settle in the state where they do their residencies because it’s convenient, he said.

Health care advocates last year suggested the state look into loan forgiveness programs and other incentives to encourage students to stay and practice in Connecticut.

Officials also are looking to increase medical school class sizes to produce more doctors.

UConn is considering larger class sizes but must ensure it has enough private practice physician sites for students to complete internships, Koeppen said.

The university receives more than 3,000 applications for 80 positions each year, he said.

The required internship allows students to provide care and interact with patients during a three-year stint.

“The issue is to make sure we have enough high-quality clinical sites, so that students are seeing the right number of patients in order to be competent in an area,” Koeppen said.

Schools in Florida and Texas are planning to increase class sizes next year. A university must receive approval from an accrediting body before it can take more students, Koeppen said.

Rodis said hospitals need to work with staff to address potential shortages and not wait for state legislation.

“I just think the hospital needs to play a very active role in this process and work collaboratively with its collective staff. By the time the state identifies shortages at the macro level, we might have severe deficiencies at the micro level,” he said.

This article originally appeared at the Stamford Advocate, but was removed. We will keep it posted for archiving purposes.