Doctors retiring earlier

By Diane Ivey

LANSING – John Dircks is a doctor of pulmonary medicine in Kalamazoo and looks forward to celebrating his retirement.

But for Dircks, retirement is about more than just enjoying his golden years.

“It’s really just not feasible to keep doing what I’m doing,” Dircks said. “I pay the overhead for the office and computers and all the secretarial staff. I go through reams and reams of insurance and billing and transcripts. It doesn’t leave enough money for me and my wife.”

Dircks, 65, is among the more than 6,000 Michigan physicians who will hang up their stethoscopes in the next 10 to 12 years.

That mass retirement will leave thousands of patients without medical care, state health experts say.

About 38 percent of the state’s physicians, particularly in the primary care, family and internal medicine fields, will retire by 2020, David Fox of the Michigan State Medical Society said.

“It’s going to be a real problem,” Fox said. “The baby boomers are hitting retirement, too, and they’re going to need more health care. The physicians who are retiring are the ones those people are going to have to see first.

“Physicians are tending to retire earlier,” Fox said. “It’s a little more difficult maintaining a medical practice now.”

The escalating exodus of doctors is due to a number of factors, Fox said. Not only are physicians retiring, but others are leaving the state due to the poor economy.

Between the declining income of patients, increased costs of staff, high medical malpractice insurance rates and more exposure to lawsuits, Fox said physicians are inclined to quit sooner.

Melanie Brim, director of the Bureau of Health Professions in the Department of Community Health, also cited the general aging of the state’s population as a reason for the expected shortage. Health professionals, including nurses, she said, are getting older.

“I’m not sure if it’s just the economy, so much as demand,” Brim said. “In part, the shortage is due to aging. Studies show that the average age of nurses is mid- to upper-40s, and nursing faculty are even older.”

Dennis Paradis, executive director of the Michigan Osteopathic Association, cited the combination of aging and primary care’s decreasing appeal to recent graduates.

“We’re definitely an aging population, requesting and requiring more services,” Paradis said. “Medicine, especially the primary care field, isn’t as attractive as it used to be. It’s not financially viable because of low insurance reimbursements.”

Brim said another key reason for the expected shortage is the problem of training and placement for doctors and nurses just out of school.

“The pipeline to replace these people just isn’t large enough,” Brim said. “There’s a gap between those we are educating and those who are retiring.”

Fox agreed, and noted that all medical school graduates must complete at least two to three years of residency before they’re able to become fully licensed physicians.

“We’re working with schools and hospitals, trying to make sure there’s enough funding for colleges and residency program training,” Fox said. “It’s very difficult to get federal funding because there’s a cap on how many residency spots the government will pay for.”

According to Paradis, the federal government has been paying for residency programs since 1967, but due to decreasing funds, the number of spots paid for could be reduced within the next year.

Brim emphasized the lack of clinical learning sites and faculty, especially for aspiring nurses. She added that her department is working on a program that will help place nurses, clinical training programs, even some out of state, that could increase placement by 20 to 30 percent.

But one medical school dean said he would not change the number of people admitted to the program, even with increasing demand.

“Our program doesn’t vary based on physician shortage or need,” said Silas Norman, an assistant dean of admissions for the medical school at Wayne State University. “Over the last several decades, our class size has been between 256-260. Two years ago we increased our class size to 290 outstanding individuals, but that’s as far as we’re willing to go.”

Another factor, according to Mike Gentile at Wayne State, is the number of women in the field.

“My theory is that due to the increasing numbers of women with medical degrees, more than half are leaving the workforce to raise families,” Gentile said.

But Paradis said women aren’t a significant factor in the declining numbers of doctors.

“People point to women a lot and say that’s why we have fewer physicians,” Paradis said. “But recent surveys indicate only 3 percent of women are leaving the field for family reasons.”

Fox said the state could increase the number of physicians, not only by better placement systems but by loan forgiveness for some future primary care physicians. He and Paradis agreed that the lack of adequate reimbursement for doctors in primary care is keeping non-physicians from choosing that field.

“It’s not a good incentive because students are already $150,000 to $200,000 in debt,” Fox said. “We want to help them with their debt and reduce the overall costs.”

Fox said he also wishes the federal government would increase funding for residency programs because the number of spots paid for don’t match the current population.

“It seems short-sighted that those programs won’t be increased, even knowing that there will be a shortage,” Fox said. “People will need doctors, and who’s going to take care of them?”

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