OCEAN CITY – Quality healthcare is a concern for everyone, but if recent trends continue, it might be the quantity of healthcare that is the greater concern.
The State of Maryland is running 16 percent below the national average for practicing physicians, and the Eastern Shore of Maryland has a shortage in 18 of the 30 physician categories, according to a study released by the Maryland Hospital Association (MHA) and MedChi, the Maryland State Medical Society.
The report says that there are “troubling statewide gaps in primary care physicians, most critically in rural areas, and we are seeing more patients turning to crowded ER’s for even minor ailments.”
What’s even more alarming is that the problem could worsen substantially in the next few years. Approximately 78 million baby boomers are set to eclipse the age of 65 by 2011 and 30 percent of America’s doctors are expected to have retired by that point.
In Maryland, a quarter of practicing physicians are over the age of 60, and many in the business, including Michael Franklin, CEO of Atlantic General Hospital in Berlin, realize the grandiose problem that is looming on the horizon for the medical field.
“It’s a major concern for us. The current population trend will hit the peak of the crisis by 2015, and we see it hitting a plateau for 5-10 years while the demand exceeds the supply,” he said.
Though AGH is not in critical need of physicians as some other hospitals in rural areas may be, Franklin said that AGH is “not fully staffed” despite its remarkable growth, but he added, “few hospitals unfortunately are fully staffed these days.”
AGH currently has a medical staff of 163 physicians, according to Franklin’s annual AGH fiscal report that he delivered to the Ocean City Mayor and Council last week.
Only 55 of those are active physicians, with a number of contingent, consulting, provisional, honorary, visiting and other types such as health professional affiliates and community affiliates rounding out that figure. Based on that same report, AGH has seen rises in admissions, surgical cases and ER visits, which at 32,482 last year virtually tripled the amount that hospitals of comparable size to AGH address.
Franklin said that one of the bigger problems is the fact that 30 percent of those that seek care at ER’s don’t have primary care physicians, thus creating longer waits and take physicians away from dealing with larger and perhaps more critical medical ailments.
There are currently almost 25,000 licensed physicians in Maryland, but what’s alarming is that 2,664 of those aren’t in practice, a number that could be attributed to the astronomical liability and insurance fees that some doctors are paying. The report says that some OB/GYN’s have paid up to $150,000 in liability insurance with private practice doctors paying around $16,000.
Franklin also alluded to the notion that many physicians desire to be a part of large hospital teams and practices, rather than own a private practice in small areas such as this.
“We see one-sies, and two-sies, all around the area, but as those doctors retire, there are few doctors that want to have small private practices,” said Franklin.
It used to be that the nation’s best and brightest went on to study medicine, but the last20 years has seen fewer doctors coming through the school systems, which is largely blamed on a cap that medical schools implied in the 1980’s.
Studies done within the medical field forecasted a vast surplus in the number of physicians nationwide, so medical schools capped the number of enrolled students at 16,000.
In the years from 1980-2005, enrollment stayed at that consistent level, but the population of the country grew by more than 70 million, according to the Association of American Medical Colleges and US Census reports. It has been cited by numerous experts in the field of medicine that this decision to cap medical school enrollments had a direct impact on the current shortages in physicians, rather than the projected surplus.
The result of this vast mistake could threaten the well being of almost 54 million Americans and could see the problem not amended until 2022 if more doctors aren’t trained, according to Dr. Robert Barish, Vice Dean of Clinical Affairs at the University of Maryland School of Medicine.
“We must act now to educate more physicians and concurrently to increase the number of funded residency positions in Maryland,” he said.
Though it seems that the amount of practicing physicians is the biggest problem, Franklin said that keeping doctors in Maryland and attracting them to smaller hospitals in rural areas like AGH is an added challenge.
“Most medical schools are in urban settings and they get used to that lifestyle, so getting them to settle down in a smaller area is sometimes tough. With the quality of schools in this area, we do much better with recruiting doctors with young families and doctors that are at the sunset points in their career,” said AGH’s Franklin
Another part of the equation is the cost to become a doctor and the pay that follows. Normally a student will leave medical school with about $150,000 to $250,000 in financial aid loans and go to areas that pay the most money. Coincidentally, Maryland ranks in the lowest 10 percent in the country for doctor reimbursement which makes recruitment of physicians and specialists a daunting task for hospital administrators like Franklin, and it makes retention all the more difficult.
Despite all these factors that many are calling in the medical profession “the perfect storm”, area hospitals like PRMC in Salisbury and AGH seem to be meeting the demand for health care despite the shortages that are projected in the Eastern Shore area.
“We fared very well in primary care, and we are looking to add on that based on demand issues. Currently, we have enough surgeons to meet all the demand as well, said Franklin.
(Editor’s Note: This story is part of an ongoing series on healthcare on the shore. Next week The Dispatch will look at how PRMC is coping with the doctor shortage and what can be done to address it in the future.)