A new comprehensive study of Maryland’s physician workforce shows that the state has a growing shortage of doctors in clinical practice, which could become dire for patients. The study, led by Robert Barish, MD, vice dean for clinical affairs at the University of Maryland School of Medicine, found that overall, Maryland is 16 percent below the national average for the number of physicians in clinical practice. The most severe problems occur in rural parts of the state and will worsen by 2015, based on the study’s findings.
Spurred by reports of projected national shortages in physician supply and specific concerns about the professional environment in Maryland, the Maryland Hospital Association invited MedChi, the Maryland State Medical Society, to join them in undertaking a comprehensive examination of the physician workforce. A steering committee, led by Dr. Barish, was formed that included physician, hospital and state agency representation.
According to the study, the widest gaps are in primary care, emergency medicine, anesthesiology, hematology/oncology, thoracic surgery and vascular surgery, psychiatry and dermatology. The study also finds Maryland has only a borderline supply of orthopedic surgeons.
The situation in Southern Maryland, Western Maryland and the Eastern Shore is the most alarming. All three regions fall significantly below national levels in currently practicing physicians. Southern Maryland at present has critical shortages in 25 of the 30 physicians categories (83.3 percent); Western Maryland 20 of 30 (66.7 percent) and the Eastern Shore 18 of 30 (60 percent).
Hospitals throughout the state report difficulty in finding medical specialists to cover patient needs and support their emergency departments. Also, the study indicates there will be future shortages in all pediatric specialties except neonatology, as well as a projected statewide shortage in diagnostic radiology.
Because of the anticipated shortage, "more patients will have to rely on already crowded emergency departments for even minor ailments," said Cal Pierson, president of the Maryland Hospital Association. "ERs will need to divert patients to other – often more distant – hospitals in order to assure the patient is seen by the appropriate specialist – at a cost to the patient’s care."
Dr. Barish pointed out that one of the reasons for these shortages is an aging workforce. "In Maryland, 9.9 percent of clinical physicians are 65 years or older and 33.4 percent of them are 55 years or older," he said. "By 2015, 32 percent of the current workforce is expected to retire. The current supply of general surgeons statewide now only meets 90 percent of what is needed; by 2015, the supply of surgeons is expected to shrink even further to 80 percent of what is needed statewide."
According to Dr. Barish, the number of residents trained at Maryland’s hospitals who opt to practice in-state is insufficient to make up for this wave of retirements. "Residency program directors indicate that the 52 percent of residents who now go on to practice in Maryland could fall to as low as 25 percent by 2015. Not nearly enough clinical practitioners will be moving into Maryland to offset these factors," he said. "Therefore, it is crucial that we act now to increase the number of residents staying in Maryland to practice medicine at the conclusion of their training.
"On the national level, we need to educate more physicians and, concurrently, increase the number of federally funded residency positions," Dr. Barish added. "It will take until 2022 to have a meaningful impact on increasing the supply of fully-qualified clinical physicians."
The study calls for a number of legislative remedies, including higher physician fees so Maryland is competitive nationally and a state loan forgiveness program that will draw young physicians to regions most in need. "We must develop incentives to encourage physicians to see Maryland as ‘physician friendly’ and to encourage them to practice in the state’s rural areas and specialty areas with the greatest shortages," said MedChi Executive Director Martin Wasserman, MD. "We must retain our current physicians and residents in training and recruit new physicians to practice in our state."
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