Barriers to physician recruitment continue

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February 11, 2008

By JEFF MEYERS The Press Republican Mon Feb 11, 2008, 10:38 AM EST

PLATTSBURGH — Local health-care leaders continue their search for new doctors to alleviate a growing physician shortage, but the process is not generating positive results.

The area has lost several physicians to illness, retirement or more favorable conditions elsewhere, and there appears to be no easy solution to the problem.

“In general, there is a physician shortage, not only locally but in the state, the country and globally,” said Dr. David Anderson, a Plattsburgh physician. “There are a lot of factors; it’s a complicated issue.”

FALLING BEHIND

Anderson, the new chief of medical staff for CVPH Medical Center, spoke recently at Plattsburgh Noon Rotary, sharing with business leaders some startling information on the physician shortage.

“Medical schools are not turning out enough physicians to meet an increasing demand,” he said, noting that shortages in primary-care doctors and psychiatrists have hit the North Country especially hard.

“There was a sense years in gone by that we were producing too many medical doctors, so medical schools slowed down. Now we are busy trying to catch up with the demand.”

PAY MATTERS

The North Country’s geography compounds that problem, he said.

“We live in an isolated area. A person who is looking for a smaller area and likes the outdoors may be attracted to our region, but to really attract people to the North Country, we need to be able to offer them financial incentives.”

Nearly half of all physicians come out of medical school with more than $175,000 in debt from student loans. That adds an immediate burden on new doctors who are trying to establish practices, particularly in a rural setting such as northern New York.

“When they are deciding what kind of specialty to turn to, they are going to consider salaries,” Anderson said.

A typical starting salary for a primary-care doctor may be around $170,000, while a specialist may start around $300,000, he said.

HELP WITH LOANS

The federal government could play a role in improving physician shortages by offering relief from education debt, Anderson said. With a federally supported plan to forgive or reduce student loans, doctors might be more willing to look into a primary-care career.

Gov. Eliot Spitzer recently introduced a proposal to reward physicians who choose to set up practice in rural communities by paying off their student loans. Combined with a federal plan, doctors would not only be able to choose rural communities but could be attracted to primary care, Anderson said.

REIMBURSEMENTS

Medical reimbursements also continue to be an obstacle to physician recruitment. Reimbursements from Medicare and private insurers to area doctors do not match payments made elsewhere, influencing many to avoid opening practices here.

“If I’m a new family physician out of training and in debt and I knew I was going to make $50,000 more elsewhere, I’d take the other option,” Anderson said.

“These doctors are trying to afford the burden of this heavy debt.”

When Anderson first established a practice in Plattsburgh 18 years ago, his overhead for doing business was 48 cents per dollar. Today, 73 cents of every dollar goes toward overhead expenses.

“Medicine is a difficult business,” he said.

The region also suffers because so many doctors operate private practices or are in small-group practices and have little leverage in negotiating for improved reimbursements. Large physician groups can negotiate more effectively with insurers, Anderson said.

LINK TO SCHOOLS

Several years ago, the region benefited from an agreement between CVPH Medical Center and the University of Vermont Medical School in which four internists annually would complete their education with a year’s training in Plattsburgh.

Many of those doctors would establish practices in the North Country because of the experience, Anderson said. But that affiliation ended when Fletcher Allen Health Care needed the internists in Burlington.

CVPH Medical Center President Stephens Mundy said the hospital is actively pursuing potential affiliations with other medical universities. He agreed that bringing internists into the region does often translate into permanent physicians for the community.

“We continue to struggle to find physicians up here,” Mundy said. “We have lots of openings, lots of opportunities for physicians to come to the North Country, but it’s not easy finding new physicians.”

REGIONAL CONCERN

The shortage impacts the smaller hospitals in the region as well. Adirondack Medical Center in Saranac Lake, for instance, has a medical staff of 48 physicians but needs to fill six openings.

AMC President Chandler Ralph has said that it often takes more than a year for the hospital to fill one position.

As with other facilities, AMC has to rely on using “traveling” physicians, which is a costly endeavor for any hospital.

E-mail Jeff Meyers at:

jmeyers@pressrepublican.com