Doctor shortage strains hospitals

Wednesday, Jan. 16, 2008

That means problems such as inconsistent primary care, long waits at the emergency room and lengthy travel to see specialists aren’t going away and will probably get worse, local medical officials say.

As a result, people’s average health care costs could rise because there aren’t enough primary care physicians to see those with chronic conditions, forcing people to wait until they must be hospitalized to seek treatment, said James J. Xinis, CEO of Calvert Memorial Hospital in Prince Frederick. And depending on the condition, more people from the region will require transportation to urban hospitals for specialized care.

‘‘That’s a very expensive way to receive primary care. ... Have we been successful to eradicate the physician shortage? Absolutely not. ... We’ve been living this for several years now so we knew that the shortage was pretty significant,” he said.

‘‘Unfortunately this study does not come as any big surprise to us,” said Christine M. Stefanides, CEO of Civista Medical Center in La Plata.

Calvert, St. Mary’s and Charles counties lack doctors in 25 of 30 medical categories including primary care, emergency medicine, anesthesiology, cardiology, general surgery and oncology.

Maryland overall is 16 percent below the national per-capita average of practicing physicians, the study found. The national average is 212 clinical full-time physicians per 100,000 people. The Maryland average is 178 physicians per 100,000 residents.

Southern Maryland is particularly hard hit for a number of reasons.

‘‘With the combination of [explosive] population growth in the area and the aging segment which is the fastest growing age group in the area, it’s difficult to get enough doctors to accommodate Southern Maryland,” Stefanides said.

The state’s high cost of living, low private insurer reimbursement fees compared to the national average and high-cost medical liability insurance make physicians hard to attract to the state, Xinis and Stefanides noted.

While former governor Robert L. Ehrlich Jr.’s malpractice insurance stabilization fund helped stabilize physicians’ rates, the MHA says tort reform — such as a cap on how much pain and suffering damages a person can collect in the state — is needed.

Western Maryland and the Eastern Shore also fall significantly below state and national levels in practicing physicians. All three regions — the most rural parts of the state — will worsen by 2015 as 32 percent of the current physician workforce retires and retention programs continue to deteriorate, according to the study.

‘‘If you take out the rural areas, Maryland is no different than the other states,” Xinis said. ‘‘There needs to be very targeted reform to getting doctors in rural areas of Maryland.”

‘‘Physicians aren’t making a fair amount of money ... it’s a major issue. We’re taking a many-pronged approach,” Stefanides said.

With money and manpower, St. Mary’s Hospital, Civista and Calvert Memorial help local doctors attract new associates, in addition to improving technology.

‘‘People aren’t going to just want to come when there’s not a facility to help them do their best work,” Stefanides said. ‘‘This is one of our highest priorities. It’s going to take more and more of our resources.”

All three hospitals are employing physicians full time, which wasn’t typical in the past. Calvert and St. Mary’s even hired a full-time physician recruiter and all three offer financial assistance like working capital loans to bring more doctors to the area.

‘‘Now, [doctors are] really looking for that security,” Stefanides said.

To allow primary care physicians to see more patients, Xinis said Calvert monitors patients doctors send so the doctor doesn’t have to visit them each day. More and more doctors nationwide are refusing emergency calls from hospitals, he added.

Statistics for the future stack up against the state. About a third of surgeons are 55 or older and one-quarter of the surgical workforce is 60 or older. The current supply of general surgeons statewide now only meets 90 percent of what is needed, according to the study. By 2015, that number will be 80 percent. At that time the number of thoracic surgeons — doctors who operate to treat diseases affecting organs in the chest — will be only half of what is necessary to meet demand.

With so many first-class medical schools in the metropolitan region, Stefanides said there is no reason why Maryland shouldn’t be able to attract and retain doctors.

But currently 52 percent of residents at Maryland hospitals choose to go on to practice as physicians in the state. This could fall to 25 percent by 2015 if legislative remedies are not enacted, the study reported.

Those include implementing state student loan forgiveness programs, raising insurance reimbursement fees and reforming state medical liability laws, Xinis and Stefanides said.

But Sen. Roy P. Dyson (D-St. Mary’s, Calvert, Charles) said those initiatives probably won’t be on the legislative table anytime soon.

‘‘Obviously when something like that comes up it raises a lot of concern. We have been looking into this ... for a long time,” he said.

But more imminent problems than physician shortages in Maryland are shortages of nurses and dentists, Dyson said.

‘‘That’s even greater at this point ... they go hand in hand ... I think though in time, with our growth ... you’re going to see a growth in the number of practitioners who will come into our area. It’s kind of hard now because we’re still viewed as a rural area,” Dyson said.

While the state has begun to increase the number of nursing and dental programs, Dyson said there are no plans to increase the capacities of the state’s two medical schools — University of Maryland and Johns Hopkins University — though Xinis said he has noticed a dwindling number of graduates each year nationwide in his own research. This could be due to less income and opportunity and more legal challenges across the board, he said.

‘‘I think what we don’t want to do is become real alarmists because we have been able to meet some of the [physician] needs,” Dyson said.

Other regional and statewide gaps include vascular surgery, psychiatry and dermatology. There is also only a ‘‘borderline” supply of orthopedic surgeons. The study indicates there will be future shortages in all pediatric specialties, except neonatology, and a projected statewide shortage in diagnostic radiology.

The nationwide shortage problem will be felt at every level, medical officials say.

‘‘It’s just like the nursing shortage. It will affect primary care” of individuals, Xinis said.

‘‘The outcome [of the study] is truly reflecting the reality ... the situation will go from very bad to critical in 2010 and 2015,” said Carol A. Paris, president-elect of the St. Mary’s County Medical Society and a Maryland State Medical Society trustee. Paris is one of the state’s physicians who will retire in 10 years.

As an example of the shortage, Paris said Southern Maryland Orthopedics has been unsuccessful for years in recruiting associates.

It needs six surgeons to meet the demand. There are currently three practicing there.

The St. Mary’s chapter will present the study to a regional meeting in April, where tri-county medical societies will convene to discuss advocacy and solutions to the problem.

‘‘If you can’t get seen, you won’t get treated. What was an easily treatable problem becomes a very expensive, critical problem. It becomes an access problem,” Paris said.

Email Kayleigh Kulp at kkulp@somdnews.com.