Hayward feeling a slight 'pinch' due to physician shortage

Will LaBreche / Web Editor/Staff Writer/Photographer

According to a report by the Wisconsin Hospital Association and the Wisconsin Medical Society, getting in to see a physician will be a growing problem in the coming years.

In 2003, the two agencies established a Task Force on Wisconsin’s Future Physician Workforce which was charged with identifying the physician shortage and exploring how the problem will grow in the next decade. Their key conclusion was that the shortage will likely grow worse unless efforts are undertaken to aggressively manage the problem.

The report stated that there is indeed a shortage of primary care physicians in rural Wisconsin and that specialty physicians such as radiologists and surgeons are even more in demand. The report determined that by 2015, demand for primary care physicians will increase by 13.5 percent, unless strategic efforts are in place to recruit physicians to rural parts of Wisconsin. On top of that, the pool of practicing physicians is projected to decrease overall.

Both of these problems, together with an aging baby boomer generation, will create significant problems for patients.

According to Tim Dullingsrud, clinic administrator at Duluth Clinic in Hayward, access and convenience are the biggest problems in local health care delivery.

“Hayward is unique in that many rural communities are not growing. Many are, at best, holding their own. Hayward is growing on top of our efforts to recruit physicians,� he said. “It’s not unlike recruiting other professionals, the difference is that there’s just a short supply. There’s roughly half the physicians going into private practice right now as there was 10 years ago.�

Hayward County Credit Union
In 2000, Wisconsin had 184 physicians for every 100,000 residents, but the problem highlighted here is that 29 percent of them are 55 years and older — meaning they are closing in on retirement.

In Hayward, Dullingsrud said, physicians range in age, experience and gender, which he said is the key to sustaining local health care delivery.

“The communities that really struggle are the ones that have four physicians all around the same age that are all within five years of retirement. They are really at a critical stage,� he added.

Replacing physicians can take more than a year, Dullingsrud pointed out. After losing two physicians in Hayward it has taken about two years to replace each position.

As stated, radiologists continue to be the most difficult specialty physicians to recruit, followed by orthopedic surgeons and anesthesiologists. Proving its case, the MHA Group, a physician recruitment firm, asserted that only 11 national searches for radiologists occurred in 1997- ‘98, but compared that figure to 230 searches which occurred in 2002-’03. For anesthesiologists, nine national searches were conducted in 1997- ‘98 but that number jumped to 134 searches in 2002- ‘03.

In Hayward, subspecialists such as radiologists, visit on a regular basis, mainly because the Hayward medical campus is supported by St. Mary’s Duluth Clinic (SMDC).

The conclusions drawn from the report paint a dreary picture of health care availability in rural areas. Of the two areas underserved in this state, patients in inner city Milwaukee and greater rural Wisconsin are the two most affected by the lack of medical personnel. Regarding current supply and demand numbers, the implications of the shortage will mean patients will be waiting longer to receive medical care, or will have to travel longer distances to receive care. The report states that because of these “barriers,� many are simply opting not to receive medical care — an issue that is of great concern.

Because it takes nearly a decade to properly educate and train physicians, taking immediate action to remedy the problem will help address the future shortage.

Medical students preparing to graduate are being “bombarded� with job offers, Dullingsrud said.

“For us it means you have to be really active in recruiting them — to make sure they know the opportunity is here,� he commented.

One way SMDC goes about recruiting physicians to rural areas is to get their practicing physicians involved early on in the training of resident medical students.

“We’ve had several of our physicians actually go into a residency program, where they participate in the training of these candidates, knowing that will also create relationships and help recruitment,� Dullingsrud said. “And, truthfully, that’s been very successful for us. These residents are going to be looking for opportunities where they want to practice. We’re participating in the training and establishing relationships.�

When asked why more students are not becoming general practice physicians, Dullingsrud responded, “I think lifestyle is one. I think the complexity of medicine has changed to where some physicians simply want to be an expert in a particular area, whether it is ear, nose and throat or dermatology. Compensation is another: family practice has traditionally not paid at the same level of some subspecialties.�

Because Hayward competes with other medical facilities across the nation to attract the best and brightest, Dullingsrud said the pay offered must be competitive.

“We are highly competitive with the offers he have out there,� he said.

“When you’re a physician in Hayward, with the call schedule you carry, you’re putting in quite a few hours. Some people are simply not willing to do that due to lifestyle conditions — whether it be family or their personal time,� he added.

But an even bigger problem is that with a nationwide physician shortage, when hospitals and clinics go into the field to recruit physicians, in a sense the problem is not being remedied. It might be that a physician is recruited to rural Wisconsin, but that physician ultimately had to come from somewhere — so the shortage continues regardless of recruitment activity.

Since the population 65 and older is predicted to grow significantly, this means increased pressures on health care on the whole. The basic conclusion drawn in the report on this issue is that there will be a double-digit increase in the demand for office visits as the population ages.

One suggestion presented in the report states that health care facilities should hire additional physician assistants and nurse practitioners to assume part of physicians’ workloads. These practitioners can be trained and educated in a shorter time frame than a physician who will require a much longer time.

This is a health care delivery model that is being embraced in Hayward.

“We’ve done a lot of things at our clinic to try to create models of care,� said Dullingsrud. “The physicians monitor the care, but we have registered nurses (RNs) do more things with patients.� This not only frees up physicians’ time, but allows them to focus on patients needing advanced or more complex care.

Matt Luedke, a Hayward physician, stated that the shortage “has forced us to look at the health care delivery model and the traditional doctor-patient model — it’s just not going to be sustainable.� Luedke suggested “team care models� where teams made up of physicians, nurses and other practitioners each care for a pool of patients.

Among the methods being used to address the problem of the physician shortage, the report points to neighboring Iowa which has developed a tracking system and database that provides real-time data about health professionals in that state. When a physician moves into the state, relocates, retires or changes offices, the database records that activity. The database also maintains how many job openings are available in the state itself.

Among the key benefits of this database, called the Iowa Health Professions Inventory (IHPI), it allows the state to monitor supply and demand as well as provide support for recruitment and retention programs.

But in Hayward, the community is lucky to be able to sustain a pool of talented physicians.

“In Hayward, I think we’re very fortunate for what we have here,� Luedke said, “even though we’re feeling a pinch right now for doctors. The services we provide continue to expand. If you traveled around the country, I think you would be hard-pressed to find a place that is going to top us.�
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