Report sounds code blue on lack of some doctors

By Phil Galewitz

Palm Beach Post Staff Writer

The wait to see a doctor in Palm Beach County may be long now, but it’s likely to get much worse.

If the existing supply holds steady, the county will have far fewer general surgeons and family doctors than it needs by 2011, according to a report the Palm Beach County Medical Society is to release today. Other specialties expected to be in short supply include obstetricians/gynecologists, thoracic surgeons and colorectal surgeons.

The report reveals for the first time the extent of the shortage of specialists providing emergency care. Moreover, it looks at what the demand will be for doctors, given population growth, in just a few years.

The study points to an aging physician population and steady population growth as factors that will cause the doctor shortage to worsen. The report assumes that the county population will grow by 10 percent during the next five years and that most doctors over age 55 will retire by 2011. It does not look at predicted supply.

But the problem is well-established. Overall, fewer than one in four area doctors handle emergencies at the county’s 14 hospitals in the fall of 2006, according to the study. The shortage is more pronounced in certain specialties. For example, 53 of the county’s 114 general surgeons provide ER care, compared with 22 of 73 neurologists and 31 of 109 ophthalmologists.

The most severe shortage is among gastroenterologists: 12 of 92 take emergency calls.

“These shortages have a real effect on patients and they are especially problematic when there are too few physicians to cover emergency room call when members of the community really need us,” said Dr. Jose Arrascue, a South Palm Beach kidney specialist and president of the county medical society.

“This report confirms what a lot of us in hospitals have been seeing,” said Dr. Michael Collins, emergency department director at Jupiter Medical Center. “We are looking at a significant deterioration in the ability of patients to access doctors, not just in the ER but overall.”

The report’s findings reflect the belief of many in the medical community that Palm Beach County is a hostile environment because of high malpractice costs and low insurance reimbursements, Collins said.

But Ron Lavater, CEO at Palms West Hospital, rejected that notion. “We have got great doctors in Palm Beach County, this is a very attractive place to live and we have great hospitals,” he said.

But he also acknowledged, “When you look at the demographics of our area, you can see the growing need for health-care providers.”

That’s why Palms West is working to recruit younger doctors and soon will have three residency training programs, he said.

The medical society issued the report on behalf of the Emergency Department Management Group, a task force of doctors, hospital executives and county health district officials that has studied the on-call doctor shortage for three years.

This year, the group asked the taxpayer-funded health district to fix the problem. The district is devising a solution it hopes will win support of doctors and hospitals, as well as state and federal regulators.

Adjusting for the age of physicians, the report predicts that the county will have a shortfall of 356 doctors in 2011. In several specialties, including thoracic surgery, psychiatry and urology, more than half the doctors are at least 50. Only 4 percent of county doctors are under 35, compared with 8 percent statewide and 16 percent nationwide.

The lack of younger doctors exacerbates the ER doctor shortage because younger doctors are more likely to want to handle emergency patients as a way to build their medical practice, said Dr. Alan Pillersdorf, a Palm Springs plastic surgeon and past medical society president.

“This study should serve as a wake-up call to our community that there may not be a doctor when they need one,” Pillersdorf said.

The county has no medical school or major teaching hospital.

That will change in August, when Florida Atlantic University offers a four-year medical degree program at its Boca Raton campus in association with the University of Miami.

Also, JFK Medical Center in Atlantis and other county hospitals plan major residency training programs for physicians in the next few years.

Many doctors have quit treating emergency patients or limited the number of days they are on call, claiming that emergencies increase their risk of getting sued and require them to treat uninsured patients who often don’t pay.

Palm Beach County doctors pay some of the highest medical malpractice insurance rates in the country, leading many to forgo coverage.

Not all doctors are pessimistic. Dr. Malcolm Dorman, who has done heart surgery for nearly 30 years in South Florida, including the past three at JFK Medical, said doctors will continue to flock to Palm Beach County.

“Quality doctors will continue to go where they can provide the best care,” said Dorman, who plans to operate past his 70th birthday. “With the wealth here, we should have the best health care in the nation.”

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