Extra
AS DOCTOR WORKFORCE AGES,
A FEAR OF SHORTAGE
By Marian Uhlman
Inquirer Staff Writer
Posted on Sun, Oct. 12, 2003
Seth Newman, 31, a general surgeon, sits in an operating room at Abington Memorial Hospital. He and his wife, Bethany Perry, also a doctor, decided to stay in Pennsylvania despite high malpractice premiums. "I would like to see the environment change. . . . If not, we will have to leave, too," he said.
David Travis has offered a spot in his booming cardiology practice to 20 doctors.
Despite a starting salary of about $180,000 and fully paid malpractice premiums, there have been no takers. Travis has looked for three years.
"It is depressing," said Travis, 38, who opened the practice in Sellersville, Bucks County, six years ago with his best friend, Todd Alderfer. "We are making good offers."
Candidates turned Travis down for more money or a less litigious climate, in such places as Kentucky. Sometimes, he even lost out to the urban allure of Philadelphia.
As Travis and medical recruiters around the nation are discovering, a good doctor - especially a young one - can be hard to find.
A number of experts fear that the nation is headed toward a doctor shortage. Some see an especially dire outlook for Pennsylvania and New Jersey.
Two trends seem to be at work: Patient demand for health care is expected to grow as Americans age. And, as the physician workforce also grows older, supply may not keep pace with demand because there may not be enough young doctors to replace old ones.
In a 2000 ranking of states based on the percentage of practicing doctors under 35, Pennsylvania and New Jersey ranked 41st, with 4.7 percent, according to Pennsylvania Medical Society data. Delaware had the highest percentage, with 8.4 percent.
In 1989, Pennsylvania ranked 12th and New Jersey 47th.
Nationwide, the percentage of young doctors dropped from 10.7 percent to 5.6 percent between 1989 and 2000, according to the Pennsylvania Medical Society.
The figures exclude medical residents.
The percentage of young doctors in the workforce appears to have peaked nationally in about 1980, according to American Medical Association data.
The nation is "just not producing enough physicians," said Dr. Richard Cooper, director of the health policy institute at the Medical College of Wisconsin in Milwaukee. "There is a shortage now, and doctors can go anywhere, and they do."
"We are already beginning to see the public having a difficult time accessing some specialists," said Edward Salsberg, executive director of the Center for Health Workforce Studies at the State University of New York at Albany.
Salsberg recently told a government panel that the nation is likely to be short about 85,000 physicians by 2020. That projection represents more than 10 percent of the number of physicians in practice today, which is about 780,000. Cooper predicted that the need would be higher - 150,000 to 200,000 more doctors.
The notion that the nation is producing enough doctors is being reexamined.
"Demand is rising and the supply is expected to be stable," Salsberg said, "and it could even decline some, depending how doctors practice."
The number of doctors has doubled since 1975, largely because medical schools expanded in the late 1960s and 1970s. That growth, however, is slowing.
According to American Medical Association data, which includes residents and retirees, the percentage of young doctors nationwide dropped from 22 percent in 1990 to 16.6 percent in 2001. During that period, as the doctor workforce aged, the actual number of young doctors under 35 is shown to rise slightly, from 134,972 to 138,907. The association said it was studying the issue of physician supply and expected to release a report later this year.
Many of today's young doctors do not plan to work as many hours as their elders. They want lives outside medicine. And experts say their ranks include more women, who tend to take time off for their own families.
These changes come at a time when the demand for health services is expected to rise, fueled by aging baby boomers and medical innovations.
Health care's changing nature prompted the Association of American Medical Colleges last year to revise its prediction for a doctor surplus. Now, the group said, it is not sure what to forecast, so it has undertaken a study.
Similarly, the Council on Graduate Medical Education, long an advocate for maintaining the status quo, concluded last month that the nation needs to start training more doctors, particularly specialists, over the next decade, said physician Carl Getto, the council's chairman. "How big a shortage will there be?" Getto asked. "I don't know... . It could be as high as 85,000."Dr. Fitzhugh Mullan, former director of the federal Bureau of Health Professions, sees no evidence of an impending shortage. Not only does the nation have enough doctors, he said, but it has enough well-trained nurse-practitioners and physician assistants to help keep up with increased patient demand.
There were 229 active physicians for every 100,000 U.S. civilians in 2001, according to the American Medical Association. That figure was up from 135 physicians for every 100,000 in 1975.
"It is time to look at how to better use what we have, rather than pouring more coal onto the fire," said Mullan, a professor of pediatrics and public health at George Washington University.
Other experts disagree, saying that parts of the system are already stretched, especially for specialists. Primary-care doctors appear to be in adequate supply, except in some rural areas, according to Merritt, Hawkins & Associates of Irving, Texas, a physician recruiting firm.
In a survey by the firm this year, about 70 percent of medical specialty residents said they had been contacted more than 50 times by job recruiters, including 43 percent who were contacted more than 100 times. That's up from 2001, when 30 percent were contacted more than 50 times.
The recruiting firm estimates that diagnostic radiologists are in such short supply that four jobs are available for every new radiologist. The situation is similar for cardiologists.
Finding specialists has become so difficult that even some prestigious medical centers are asking for help, which they had not done before, said Kurt Mosley, vice president of business development at Merritt Hawkins.
"It's like the Yankees going out and begging for players," he said.
In the Philadelphia area, the firm probably has conducted more searches in the last year than in the previous 10 combined, said Steve Marsh, vice president for recruiting in the company's eastern division.
Among states in the Northeast, New Jersey and Pennsylvania "are the most difficult states to recruit to" because of their high malpractice rates and low reimbursements from patients' insurance, Marsh said. Unless that changes, he said, "the number of physicians and quality of physicians practicing in those states" will decline.
It's easiest to sell North Carolina, Texas, California, Washington and New York to any physician - not just the younger ones, he said. A variety of reasons make these states appealing, including lifestyle, cost of living, weather and malpractice climate.
Mark Olesnicky, president of the Medical Society of New Jersey, said high overhead costs, such as employee salaries and rental space, have kept young doctors away for years. Rising malpractice premiums are making the situation worse, he said.
Every state "is dropping young people, but Pennsylvania is dropping at a faster rate," said Ed Dench, president of the Pennsylvania Medical Society.
He blames malpractice insurance costs, low reimbursement rates, and fierce national competition for many specialists. "It's the perfect storm," he said.
Seth Newman, 31, is a general surgeon who decided to stay in Pennsylvania. He and his wife, Bethany Perry, an obstetrician-gynecologist, enjoy practicing at Abington Memorial Hospital. "I do wonder whether I made the right decision some days," Newman said.
He had trouble finding a private company willing to offer liability coverage to young surgeons. He went through the 13-day closing of Abington's trauma services when many hospital surgeons walked out last December to protest high malpractice premiums. He has watched young doctors move to avoid such problems.
Newman also has seen the difficulty his practice has had recruiting a vascular surgeon. The practice has tried for three years. To keep up with growing patient demand, he and his partners have taken on more cases.
"I am not a fair-weather fan of Pennsylvania," Newman said. "I would like to see the environment change... . I hopefully can ride it out... . If not, we will have to leave, too."