Physician shortage looms in Maryland

by Steve Berberich | Staff Writer

Widespread shortages in many physician specialties can be expected by 2015 in Maryland, especially in rural counties, unless action is taken soon, said a committee of top medical experts in an unpublished report due to the state government next month.

‘‘I think this is just a small piece of a bigger problem,� Sen. Thomas M. Middleton (D-Dist. 28) of Waldorf said of the report. ‘‘My gut feeling is that we are approaching a crisis in primary care doctors.�

Middleton said that even as a well-known official, he has had to try several times to find a good primary care physician.

The report cites as factors several converging trends: high rates of physician retirements, more health care needs for aging baby boomers, low insurance reimbursements for physicians relative to other states, flight of medical students and new physicians from Maryland, and more foreign competition for physicians.

The report recommends capping medical malpractice awards, forgiving medical school loans for new rural physicians, rotating physicians into rural areas, increasing student slots in medical schools, and new legislation to give Maryland physicians relief from their allegedly decreasing reimbursement rates.

The Maryland Physician Workforce Study steering committee of 11 medical experts looked at locations and numbers of 30 major specialties, from primary care to surgery and psychiatry. It found that counties on the Eastern Shore and in Western and Southern Maryland already have shortages of 62 percent, 69 percent and 86 percent, respectively, in the 30 specialties. Unless its recommendations are adopted, the committee projected shortages by 2015 of 59 percent on the Eastern Shore, 76 percent in Western Maryland and 93 percent in Southern Maryland.

Statewide shortages already exist in primary care, psychiatry, hematology, oncology, anesthesiology, emergency medicine, pathology, general surgery, thoracic surgery and vascular surgery, with a ‘‘borderline supply‘‘ in orthopedic surgery.

The committee was formed at mid-year by the Maryland Hospital Association and the Maryland State Medical Society, known as MedChi.

The committee last week presented its preliminary report to the Governor’s Health Care Access & Reimbursement Task Force, a group created by a new law to develop recommendations for the General Assembly and the governor on physician reimbursement and health care trends in the state.

The steering committee will brief the General Assembly early in the legislative session that starts Jan. 9, said task force Chairman John Colmers, secretary of the state Department of Health and Mental Hygiene.

Colmers and Middleton agreed to meet to discuss possible legislation.

More physicians retiring,new physicians leaving

Maryland ranks sixth in the nation in physicians older than 60, with 25.2 percent, according to a recent study by the American Association of Medical Colleges.

Prince George’s and Montgomery counties will be most affected by physician retirements, according to the state report. The two counties already show shortages in primary care, hematology, oncology, psychiatry, anesthesiology, diagnostic radiology, pathology, general surgery and neurosurgery.

Baltimore and five surrounding counties represent the only Maryland region without a shortage of primary care physicians, but just barely. That region does have shortages of physicians in dermatology, hematology-oncology, emergency, pathology and thoracic medicine.

Meanwhile, the committee found that the state retains only 35 percent of its physicians who completed their residency in the state, ranking 24th in the nation.

Robert A. Barish, vice dean for clinical affairs for the University of Maryland School of Medicine, told the task force that ‘‘even if we increased the size of [medical school] classes and built more medical schools, we will still not have enough physicians to train these students.� Medical schools face declining enrollments nationally.

The American Association of Medical Colleges recently called for a 30 percent increase in enrollment in 10 years.

‘‘We do have plenty of applicants for medical schools,� but time is of the essence, Barish said. Beefing up enrollment by 2015 still will not produce many practicing specialty physicians until at least 2026.

More than justbaby boom numbers

The U.S. Census Bureau reports that by 2030, the current 35 million elderly will double to 70 million. That will mean not just more patients, but more doctor visits, too, Barish said.

The annual National Ambulatory Medical Care surveys showed that seniors, on average, visited a physician one or two times more in 2004 than in 1990. Patients 65 to 85 years old visit a doctor about six to eight times annually.

The committee also reports increased competition abroad for Maryland-trained doctors. The British government, for example, has adopted a policy of attracting 65,000 more English-speaking doctors.

The Maryland Hospital Association has endorsed the report’s recommendations, said committee members. The MedChi board will soon consider them, said Executive Director Martin Wasserman.

At first glance, the numbers of Maryland physicians reported by the committee clashes with the number reported by the American Association of Medical College’s State Physician Workforce 2007 Data Book. According to those data, Maryland ranks second in the nation with 355 physicians per 100,000 population. But the committee drilled down further to count only active full-time clinical physicians.

A snapshot of the 24,968 physicians currently licensed in Maryland shows there are only 10,227 practicing full-time clinicians, Barish said. The others are federally employed, practice out of state, are not practicing at all, or did not renew their license.

Many of Maryland’s doctors work for four major medical schools in the immediate region — the University of Maryland, Johns Hopkins, Georgetown and George Washington hospitals — and are not clinical physicians, according to the Maryland Health Care Commission.
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