When his longtime physician retired, Southern Maryland lawmaker Thomas "Mac" Middleton faced a predicament: The senator needed a new doctor but couldn't find one who was taking new patients. "I had to go through three different doctor groups before someone would take me," he said.
He ran right into the critical doctor shortage facing rural Maryland - to the west of Baltimore, to the south, on the Eastern Shore.
There are not enough primary-care doctors setting up practice in these areas, leaving some residents without access to basic health care and leading to more costly and serious illnesses, doctors say. Those doctors - and many specialists - are reluctant to leave the city for the country, where they typically get paid less, work more and find fewer job opportunities for their spouses, who aren't always ready to give up the trappings of life near an urban area.
Middleton and other legislators in Annapolis are now seeking ways to recruit and retain physicians to care for people in large swaths of Maryland.
"We have areas where you just can't get care - you have to leave and go to another jurisdiction," said Gene Ransom III, executive director of the Maryland State Medical Society, or MedChi. "It's a real problem for people, especially for people who can't afford to do that."
There used to be 10 obstetrician/gynecologists in Allegany County, for example; now there are four. There is just one psychiatrist in St. Mary's County. The wait to see a new primary-care doctor on the Eastern Shore can be weeks - if that doctor is even seeing new patients.
Lawmakers - who worked on two task forces last year that looked at different parts of the issue - are considering both short- and long-term fixes. Solutions could include a loan forgiveness program for primary-care doctors and specialists in rural areas who agree to remain in those communities for a certain number of years. Newly qualified doctors come with as much as $200,000 in student loan debt, and earning enough to keep up with the payments can be difficult, especially in rural areas.
There has been a small loan forgiveness program in the state, but Sen. Rob Garagiola, a Montgomery County Democrat, called it "very inadequate."
He worries that in this tight economy it might be difficult to sell a plan that sends money to such a program, but he thinks that the current proposal could fly. By building a fraction, less than 10 cents per $100, into state hospital rates, a fund could be created to pay down close to $14 million in debt for doctors who agree to practice in underserved areas.
