Symptoms of a doctor shortage

Growing population, physicians' desire to cut workweeks add up to a deficit

October 16, 2005|By JULIE BELL | JULIE BELL,SUN REPORTER

Don't be surprised if you have a hard time getting in to see certain doctors: There already are signs of the physician shortage many experts predict in a few years.

Nationally, surveys point to long wait times for cardiologists, dermatologists, orthopedic surgeons and obstetricians in many cities, while Maryland physicians say there are signs of a shortage of anesthesiologists, general surgeons and family doctors.

"We can't see all the patients who want to see us," said Dr. Dana Frank, a Lutherville internist whose first available nonurgent appointments are in March.

"We are overwhelmed, and that is because there is a shortage" of internists and family practitioners.

The problems are nothing new in some rural and inner-city areas that many doctors consider so financially unattractive that the government offers incentives to practice there. But nationally, experts say shortages are expected to worsen in those areas and spread into others.

The reasons include a growing population, especially elderly people who need more care, and prosperous consumers who demand the latest drugs, medical devices or therapies.

At the same time demand is increasing, work force trends indicate some doctors are working fewer hours, while the overall number of physicians entering certain specialties - such as family medicine - remains depressed.

In Maryland, physicians complain that low insurer reimbursement, compared with other states, creates a disadvantage in recruiting some specialists.

Concerned about the apparent trends, the Council on Graduate Medical Education has recommended that U.S. medical schools increase enrollment in the next decade by 15 percent over 2002 levels and that the government fund more residencies. Some medical schools already have taken steps.

The University of New Mexico is moving to increase medical school enrollment from 75 to 100 students, and the University of Maryland School of Medicine increased its enrollment to about 150 per class from about 135 several years ago.

But limits on government funding for residencies remain, and if trends don't change there could be a shortage of up to 96,000 U.S. physicians by 2020, the Council on Graduate Medical Education says. One reason: Doctors are aging, too, and large numbers are expected to retire just when elderly baby boomers need more care.

"If something is not in the pipeline now, we're not going to produce it in 2015," said Edward Salsberg, director of the Association of American Medical Colleges' Center for Workforce Studies. "We better get moving."

The American Medical Association ranks Maryland third among all states in the number of physicians per capita who are involved in patient care. That there are so many doctors is one reason insurers are able to pay them less compared with other states, says a report by the Maryland Health Care Commission.

But doctors say the overall numbers don't change their perception that there are spot shortages in certain specialties, such as family medicine and general surgery.

Nationally, only about 37 percent of new physicians are going into generalist practices, the council says.

In Annapolis, Anne Arundel Medical Center began hiring general surgeons this spring because some surgeons in private practice left the community and there weren't enough left to comfortably cover emergency room calls, said Dr. Joseph Moser, the hospital's vice president of medical affairs. The move means hospital-employed surgeons, known as hospitalists, now handle most emergency cases, while the general surgeons still in private practice in the area focus on non-emergency ones.

"The problem was when you took ER call, you were too tired to work the next day," said Dr. Jerrilyn Jutton, a general surgeon who said her patients had to be rescheduled and wait for days or weeks for new appointments. "The hospital was smart enough to see the entire general surgery department was going down the toilet."

Kurt Mosley, vice president of business development for Merritt Hawkins & Associates, a physician placement firm, encountered the shortage when he broke his foot. His primary care physician referred him to a Dallas orthopedic surgeon, who told Mosley, "I can see you in three weeks."

Mosley got to see another doctor quickly only by using his connections. He went through a list of surgeons his company had recently placed in a job, called up and got in.

"It's idiotic," Mosley said. "The shortage is not a joke. It's true, and it's serious."

In Lafayette, Ind., Dr. Edward Langston talks of the need for heart, kidney, lung and gastrointestinal specialists, while his own seven-doctor family practice group has been trying unsuccessfully for two years to recruit physicians. In New Mexico, a shortage of specialists means a three- to four-month wait for a colonoscopy, said Randy Marshall, executive director of the New Mexico Medical Society.

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