Surgeon shortage a 'crisis'

Sep 28, 2008 (The Times-Tribune – McClatchy-Tribune Information Services via COMTEX) — WMT | Quote | Chart | News | PowerRating — Lackawanna County has a serious shortage of general surgeons that is causing patients to wait up to nine weeks for operations or go out of the area for treatment.

Wait times to see a local surgeon for an elective procedure range from four to six weeks, plus another two to three weeks to get into the operating room. Area doctors emphasize people with cancer, suspicious lumps and urgent cases are squeezed in immediately.

When Scranton general surgeon Edward Blasko, M.D., moves his solo practice to North Carolina in mid-October, the county’s shortage will worsen severely.

“My concern is there may be nights that emergency rooms go undercovered, and people with relatively routine conditions may have to be sent to other institutions,” said Timothy Farrell, M.D., of Northeastern Surgical Specialists P.C. in Dunmore.

Lackawanna County will have just 10 general surgeons and five vascular surgeons when Dr. Blasko departs. They must cover three Scranton hospitals’ emergency departments at all times and handle a growing number of elective surgeries.

Lackawanna had 31 general and vascular surgeons in 1996. The bulk have since retired, moved or died, and just three new general surgeons came to and stayed in the area since then, according to Delta Medix, Scranton’s largest multi-speciality surgery practice. Even then, the latest arrival is John Crews, M.D., of Maxis Surgical Services, who only operates in Carbondale after moving to the area in 2007.

“We can’t continue down this path,” said Margo Opsasnick, CEO of Delta Medix. “Something will give.”

General surgeons are critical for largely rural regions like Northeast Pennsylvania, which also lacks specialists, because they’re versatile enough to remove a gallbladder, cut out an appendix and fix a hernia.

In 2004, seven Delta Medix surgeons performed roughly 6,000 procedures. The practice now has six surgeons. They’ve done more than 4,800 surgeries for the first eight months of 2008 and is on pace to perform 7,100 or 18 percent more than in 2004.

The county’s general surgeon shortage “is a real crisis,” said Robert Wright, M.D., president of Scranton-Temple Residency Program. “Routine surgeries are even going out of town because of the shortage and the waiting time.”

Blue Cross of Northeastern Pennsylvania’s statistics bolster that assertion. Between 2005 and 2006, the total amount of care Northeast Pennsylvnia residents sought outside the region jumped to $1.2 billion from $750 million. That makes health care premiums rise because care outside the local area is more expensive.

For now, the general surgeons who remain will absorb Dr. Blasko’s practice, but the effect will be even longer wait times and more strain on doctors covering emergency rooms, said Dr. Farrell.

In busy times, surgeons employed by CMC, at the facility’s NEPA Trauma Center, also act as a backstop by performing some general surgeries, said John Nilsson, CMC’s interim president and CEO.

Across Lackawanna County, the shortfall of general surgeons mirrors a national and statewide dearth and an overall lack of physicians such as primary care doctors.

Medical schools have increased admissions in the last five years, but for decades faulty projections that said America would have a glut of doctors led schools to keep admissions flat as the U.S. population grew.

Meanwhile, more medical students are becoming specialists for the less hectic lifestyle and higher earning power. With the U.S. lacking doctors, physicians can move anywhere, and they’re not choosing Lackawanna County.

“The consequence of the physician shortage is people will die because of the lack of proximity to the very care and expertise they need,” said Richard “Buzz” Cooper, a senior fellow with the Leonard David Institute of Health Economics and a University of Pennsylvania Medical School professor.

For Dr. Blasko, the decision to move his nearly 20-year-old practice to North Carolina hinged on Pennsylvania lawmakers’ failure to extend a popular medical malpractice insurance subsidy.

Gov. Ed Rendell and Democratic House lawmakers let the Mcare insurance subsidy expire April 28 because Senate Republicans don’t want to approve a major expansion of a state-subsidized health care program for uninsured adults.

Republicans, who introduced their own bills to make health care accessible and affordable, question how the state can afford dramatically expanding benefits. They think the health insurance issue and Mcare should be decoupled.

In the interim, doctors have had to make the medical malpractice payments the state covered, which lawmakers said would be refunded if Mcare is eventually extended. Dr. Blasko recently received an unexpected $15,000 bill.

“It’s increasingly hard to be a doctor locally unless you’re a Wal-Mart(-sized) practice,” Dr. Blasko said. “Doctors are being squeezed by premiums, malpractice and the Mcare situation, overhead costs and all the paperwork.”

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