Health Coalition on Liability and Access

Dave Gardner, Northeast Pennsylvania Business Journal
September 5, 2006

Where have all the doctors gone?

Whatever the answer, a shortage of physicians and a maldistribution of their services exist both nationally and in northeastern Pennsylvania. Robert Wright, M.D., director of the Scranton Temple Residency Program (STRP), and one of the driving forces behind creation of the proposed medical college of NEPA points to predictions that a 200,000 physician shortage will occur nationally by 2020, and explains that the new NEPA school will help to achieve a vital renewal of medical manpower. A comprehensive study of feasibility for the new NEPA school that was completed by Tripp Umbach, a national consulting firm, says, "Quality of care is a concern relative to students educated in Caribbean or Central American medical colleges...Because the offshore medical colleges do not have to meet the requirements set by the Liaison Committee for Medical Education (LCME), there is no way for the U.S. to monitor the quality of the medical education provided by these colleges."

Tripp Umbach specifically sounds the alarm bells for NEPA by stating, "Both Lackawanna and Luzerne Counties, along with other counties in NEPA, contain federally designated Health Profession Shortage Areas...An additional concern is that 34 percent of physicians in NEPA are age 55 or older, and therefore likely to retire in the next 10 to 15 years." According to Dr. Wright, compelling evidence exists that physicians stay in the area where they completed their medical residence. Most graduate from college at age 21, and are 25 years of age when they finish medical school.

The student's medical residence then ends at age 28 to 32, when both personal and professional roots are being established. Of STRP's 220 graduates, more than 100 still practice medicine here.

The new medical college will enroll approximately 60 students during the first year of operation in 2009, with the total growing to 90 in the fourth year. Dr. Wright states that the school will have to carefully deal with admissions, and establish a priority for students who wish to come to NEPA and potentially practice in the region. Dr. Wright acknowledges that economic reasons also exist for the NEPA physician shortage, and that some of these cannot be completely remedied by the addition of the regional medical school.

Malpractice concerns are one, but he adds that awards in court are decreasing because of an increasing awareness by juries and the public that these payouts are not "pockets of endless depth."

He also states that Medicare reimbursement rates remain a problem that must be adjusted. When discussing the subject of rural physicians, Dr. Wright says these medical practices require a special type of doctor who must be able to function at all hours with no backup. "For rural primary care, the data indicates physicians are best drawn from older students, females and students of rural backgrounds," says Dr. Wright. "These are the keys. This type of doctor is a true generalist, attracted to doing a lot of things." For physicians who choose specialty practices, shortages are also a reality. Dr. Wright says a shortage of surgeons is a current problem, and that the surgeon's lifestyle affects the choice of this career because surgeons often receive late night calls to come to hospitals.

"These are issues we all struggle with, and there are no easy answers," explains Dr. Wright. "But, the right leadership in a school attracts the right students." Dr. Robert Bowman, associate professor, Department of Family Medicine, University of Nebraska Medical Center, is an expert on medical manpower issues. He explains that the national physician shortage is also a matter of complex socio-economic problems. "The United States is a nation that concentrates things and, the fact is, physicians concentrate at medical centers due to the realities of better income and facilities," says Dr. Bowman. "People also are creatures of habit, and repeatedly go to places they're familiar with. They often want to go back to where they grew up."

Dr. Bowman believes certain types of physician shortages can be traced to a failure of education for lower income families. On a national scale, physician admissions tend to follow socio-economic factors, and family physicians tend to practice where they grew up, the result being higher-income urban areas getting more than their fair share of physicians.

Low-income males, generally not as well educated as their more prosperous counterparts, are not well-represented in medical school admissions - however, lower-income females are helping to reverse this momentum. "We must have a mix of admissions to serve today's increasingly diverse society," says Dr. Bowman. "For example, a Washington,, D.C. child has poor prospects for a college career, but a child born in Utah has very good prospects. The implications are less and less access to medical care for our rural and low-income areas."

Dr. Bowman defines the NEPA medical market as one that is "between" rural and urban healthcare environments.

He identifies Duluth, Minn. and Mercer, Ga. as similar regions, and says lessons can be learned from these areas that will benefit the new NEPA medical college. "For these markets, a school's admissions policy should encourage the right type of students to fill the area's medical manpower needs, and focus on kids of character," says Dr. Bowman. "You must pick the right students. For example, family practice students tend to be older, and have been out in the world longer."

Looking at the physician shortage and maldistribution problem from a long-term perspective, Dr. Bowman says the national health policy should change. He believes a manpower pipeline should be developed between the public schools and medical colleges. "This would get all kids ready for education, including those from the lower socio-economic range," says Dr. Bowman. "To accomplish this, it would require a lifetime of change. Washington, D.C. and New Orleans are models of not doing this. These cities neglected their educational infrastructure for 20 years, and a lack of medical students is the result. There's no magic wand to fix this, only hard work and sacrifice."

"We need to recruit older students, because they are often more comfortable with rural areas," says Dr. Bowman. "Older folks also have better educations, in many cases." Less emphasis by schools on the Medical College Admission Test (MCAT) is another step being suggested by Dr. Bowman. He believes this exam is really a socio-economic development test, and low- and middle-income kids often do worse on standardized testing than private school students.