Ohio lawmakers seek ways to halt physician exodus


Using northwest Ohio as its laboratory, state lawmakers have proposed a huge task force to figure out what Ohio can do to keep medical school graduates from fleeing the state for greener residency programs and homes elsewhere.

“If you look at the workforce of the state, particularly northwest Ohio, we are a net exporter of physicians, while our physician base is aging,” said Dr. Jeffrey P. Gold, dean of the University of Toledo’s medical school, the former Medical College of Ohio.

“Ohio is a poster child for the country,” he said. “Northwest Ohio is the poster child for our state. This is a unique opportunity to draw sunlight into this area and think creatively about how to fix these problems.”

Such a study commission is likely to revive debate in Toledo and potentially in Columbus on the hot-potato subject of medical malpractice insurance rates as well as such issues as loan forgiveness, tax incentives, Medicaid provider, the number of specialty residency programs offered, and where those programs are based.

“We know full well that there’s a 50-50 chance that a resident will practice within 50 miles of where he did his residency,” said Dr. Anthony Armstrong, president of the Ohio Academy of Medicine of Toledo and Lucas County. “We have an 8 percent retention rate from the [UT] medical school. That’s terrible. We can’t keep anybody here.”

As unwieldy as its title – the Commission on the Future of Health Care Education and Physical Retention in Northwest Ohio – is its proposed size. It would consist of 27 members and would include diverse representation of doctors, nurses, state legislators, UT, labor, business, insurers, local government officials, hospitals, and patients.

The nine-month task force was added at the request of Rep. Peter Ujvagi (D., Toledo) to the proposed $52.1 billion, two-year budget that was unanimously approved recently in the Ohio House. The bill is now pending in the Senate.

The budget provides no funding for the study, counting on the Toledo Community Foundation to provide administrative support and the Ohio Board of Regents to function as the commission’s resource library. Gov. Ted Strickland and legislative leaders would appoint the commission members and its report would be on their desks by March, 2008.

“If you were to go to an average member of our graduating medical class and ask whether they would stay in northwest Ohio, and 92 percent are not – most say they are willing to do that, but the specialties that they want are not available,” said Dr. Gold. “Each year, our students, based on national standard examinations and the history of former graduates, have been much more marketable commodities, and they are being recruited into the most prestigious programs in Boston, New York, Philadelphia, Atlanta, San Francisco, and Los Angeles.

“Even if the educational quality were the same and there was equal financial opportunity, some would lean anyway toward Boston versus northwest Ohio,” he said.

The commission is seen as the ultimate extension of what has been a complete mind-set turnaround in Columbus. After several years of looking to higher education for cash whenever finances were tight, the latest budget places much greater emphasis on higher education as an economic development driver.

The House-passed budget puts more resources behind producing graduates in science, technology, engineering, and mathematics. But how do you keep those graduates once you’ve produced them?

“We’re ripe for this conversation,” said Rep. Mark Wagoner (R., Ottawa Hills). “We should go into it with an open mind, take testimony, learn what’s happening, and reach some consensus. … At a time when we’re trying to improve higher education and putting more resources into it, the next step is to improve the graduate medical education programs.”

Tim Maglione, spokesman for the Ohio State Medical Association, said such a commission could raise general awareness of how much it costs to maintain physician practices in Ohio.

“Their reimbursement by Medicare and Medicaid have been essentially flat over the last six years, but their expenses have gone up dramatically when you count medical malpractice insurance, health-care insurance provided to employees, employee wages, and medical technology,” he said.

Sen. Randy Gardner (R., Bowling Green) said it’s too early to predict how the commission will fare as the Senate puts its imprint on the budget. But he expressed concern that a 27-member commission could prove cumbersome.

“There are a variety of views in the Toledo area as to how to address the issue or what caused the issue,” he said. “There may be some turf concerns, but it’s important to talk about it. This may provide brighter focus on the problem.”

Keith Burwell, president of the philanthropic Toledo Community Foundation, said it has not committed itself to any role in the process, but he thinks he can find a table big enough to accommodate a 27-member commission.

“It will be a daunting task,” he said. “Most of those folks are community folks. They know each other, but we’re just learning about this like everyone else.”
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