Connecticut has trouble attracting new doctors

News-Times Staff
http://www.newstimes.com

I was alarmed to learn recently that 20 percent of the doctors in Connecticut are over the age of 60, and most of those are surgeons.

What makes matters even worse is the fact that medical residents looking for positions regard Connecticut fifth from last in the nation for desirability to set up a medical practice, just below Mississippi.

The average wait time to recruit a new medical partner in Connecticut is five years.

As Dr. Robert Biondino, president of the Connecticut Orthopedic Society, pointed out in a recent issue of the organization’s publication “Backbone,” Connecticut is already experiencing serious shortfalls in hospital emergency room coverage — to the extent that our legislators are considering making ER coverage a condition of licensure.

What we need to do is present a list to legislators of things that would make Connecticut a more desirable place to practice medicine. I would propose the following:

Restore physicians’ autonomy in the decisions we have to make on behalf of our patients.

Between the callousness of our workers’ compensation system and the avarice of managed care, our capacity to order tests and procedures has been eroded to the point where our professionalism is being challenged on a daily basis.

Clinical practices and referral patterns mandated by “the system” yield a production-line mentality and a schism in the doctor-patient relationship.

Reimburse physicians fairly for the services they provide.

Medicaid rates have been unchanged since 1986, and Medicare rates have been declining (relative to inflation) since 1991. This is despite the fact that we are doing more complex procedures faster, at less cost, and with better outcomes than ever before.

“Relative Value Resource Based Systems” coding, used by government and private insurers to determine reimbursement, has reduced us to factory worker status.

By ignoring the special talents, experience and expertise of physicians, we are discouraging the quest for excellence. This will be reflected in the quality of the next generation of physicians.

Get rid of the “Stark Laws,” which govern physician referrals under Medicare and Medicaid.

What an affront and insult it is to our professionalism to presume that because we own an imaging device or a therapy center we will refer our patients to our facilities unnecessarily. Does not ownership motivate us to maximize quality?

Why did we let our lawmakers tarnish our ethical image to the public to this extent? This, when health maintenance organizations are allowed to collude, to fix prices and fee schedules, and to get lucrative kickbacks from the pharmaceutical companies and vendors they utilize.

Tort reform, tort reform, tort reform. In a state where 16 members of the legislature’s 43-member Judiciary Committee are attorneys, including the two Democratic co-chairmen and the two ranking Republicans, tort reform appears to be no more than a fleeting fantasy.

Yet 45 percent of prospective medical residents feel that a state’s medical liability climate has a major impact on their decision to practice there. Prospective recruits are turned off by the juxtaposition of Connecticut’s high cost of living and our high malpractice premiums.

Connecticut, the first state to implement no-fault car insurance, needs to replace our current broken system of medical liability with an administrative model (like workers’ compensation).

Expunge the notion that the medical and pharmaceutical industries have an unholy alliance with physicians.

As the costs and requirements of continuing medical education escalate, companies should be allowed to conduct seminars on their products, which physicians can attend free of charge and without the stigma of “conflict of interest.”

Doctors should be allowed to claim this experience as continuing medical education credits.

If a surgeon invents a new instrument or procedure, he should be allowed to apply his name — just as is done throughout the entire business world.

Today, most medical research is being done by private industry (not academia), and our close association should be considered a benefit to society.

Do not make licensure contingent upon taking ER calls. An ad hoc committee in Connecticut is looking into ways to address this problem, and requiring ER calls will only make the problem precipitously worse.

The Connecticut General Assembly is considering realistic options to attract new physicians to the state — such as forgiving student loan debts — but that may not be enough to persuade medical residents who place quality of life as a high priority and who are willing to search the nation for a favorable position.

Can you think of other incentives our legislature should consider? Ranking just below Mississippi as a desirable place to start a medical practice is unacceptable.

Ronald A. Ripps, M.D., is a Danbury orthopedic surgeon.

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