Health officials sound alarm over looming doctor shortage

REGION – Northwest Michigan and state health officials are racing to deal with a looming physician shortage, and there's no easy cure for it in sight.

The situation hasn't impaired the delivery of care yet – thanks in part to state and local physician recruitment efforts. Still, many practices have taken on about as many patients as they can handle.

In coming years, physician groups may be pushed to the limit as the aging baby-boomer generation needs more medical care. At the same time, physicians of that generation are due to retire.

In the worse case scenario, a doctor shortfall could mean longer waits for appointments and delayed diagnosis and treatments. In that hyper-extended medical environment, both the satisfaction of patients with their care and of physicians with their jobs could easily plummet.

"There is going to be excess demand at the same time there is a shortage of physicians," said Dr. David McGreaham, M.D, vice president of medical affairs at Munson Medical Center, who helps to oversee physician recruiting. "We are going to have to fill those slots with new physicians."

Munson Healthcare may well have to add roughly 20 to 25 doctors to the Traverse City area and about 40 system-wide a year to cope with the shortfall. Even today, some gaps in medical sub-specialties such as neurology, rheumatology and psychiatry have emerged.

The problem isn't restricted to the region. A full 41 percent of active physicians in Michigan say they plan to stop practicing in 10 years or less, according to the Michigan Health Council. Meanwhile, 61 percent of physicians in Michigan say their practice is full or nearly full, compared to 42 percent in 2005.

Beyond Michigan, similar demographic factors are playing out, making the race for new medical talent all the more urgent.

Munson Medical Center and its regional umbrella entity, Munson Healthcare, are working with physician groups to deal with the situation, McGreaham said. They anticipate adding 15 doctors this year. Last year, they brought 15 to Munson Medical Center and another 17 to the rest of the regional system.

"We know that things are more competitive and we are expanding the scope and intensity of what we are doing," McGreaham said.

As most physicians join groups, Munson works closely with them to attract new medical talent. While some young doctors are looking for direct employment, Traverse City's regional medical center has mostly stayed with the group model. It is willing to contribute to the financial security of doctors coming here, however.

"We have to make sure that we are competitive with moving expenses, signing bonuses or income guarantees," McGreaham said. "We work with the groups to offer compensation packages."

This is all the more important since the financial environment for doctors in Michigan is making it hard to recruit young doctors.

"The state of Michigan is not necessarily an attractive place to practice," he said.

Blue Cross-Blue Shield tends to reimburse physicians in Michigan less than its counterparts do in other states. "We have the lowest Blue Cross reimbursement in the Midwest," McGreaham said. "And out of 50 states in the union, we are 49th as a provider of Medicaid reimbursement. So you have those two things going against the state."

To counteract those harsh financial realities, the State of Michigan is already using an array of tools to retain and attract physicians. One tactic is to repay $50,000 of a doctor's loan in exchange for a minimum of two years' work in communities where they are badly needed. That's no small help to a physician emerging from his or her medical training with the typical $150,000 debt.

"It's the largest loan repayment program in the country," said Steven Creamer, manager of Michigan Health Workforce Development in Lansing. Those loans directly increase a doctors' ability to practice in northern Michigan. "If their debts are high, then they may not be able to. But if there is loan repayment, then they just might move up there."

Key hospitals in rural areas, known as "critical access hospitals," get priority in the loan repayment program. They include Paul Oliver Memorial Hospital in Frankfort and Kalkaska Memorial Health Center.

Selling TC

Success in attracting physicians often depends on the community itself. By most standards, Traverse City is an attractive community. Physicians familiar with the area are prime candidates for recruitment. Unfortunately, not everybody wants to live in a community this size.

For instance, foreign-born specialists – who are seen as one piece of the solution – typically want to practice in ethnically diverse communities. For all its natural attractions and the allure of its small scale, Traverse City ranks low on that score. "We are challenged by our lack of ethnic diversity," McGreaham said.

While Traverse City's size and make-up may be a drawback to some candidates, it is certainly an attraction for many others. Traverse City's vibrant downtown is a plus, as is Interlochen and other cultural institutions.

"We have a well-respected hospital and medical center here. And we have great physicians and nurses here, along with many excellent clinical programs, and that is also a great draw," he said.

The community can help with physician recruitment by continuing to make improvements in the quality of life. As they shop for their new home, for example, doctors care deeply about the quality of local schools. So any efforts to maintain and improve public education quality will pay dividends.

Kim Burley, director of physician services at the Michigan Health Council, said Traverse City ranks behind four other Michigan regions – the Metro Detroit, Grand Rapids, Kalamazoo and Lansing areas – in its desirability to doctors. "It's a niche market," said Burley, who helps recruit physicians to the state.

She based her conclusions on the 500 to 600 calls her office makes every week to doctors around the country.

The situation becomes more serious beyond the more populated areas, she said. "The more rural the community, the much more difficult it is to recruit to it."

One problem is that spouses with professional careers look for opportunities that advance their own career ambitions. A medium-sized community or rural area will typically have fewer options than major cities.

Tele-docs

While new technologies could be part of a solution, McGreaham sees telemedicine mostly as a way to provide care over huge distances – perhaps 120 miles or more.

So it may be more appropriate for more rural states like Montana or the Dakotas. In much of northern Michigan, patients prefer to see specialists in person. As a result, they may be comfortable driving an hour or more to visit them.

"We do continue to study telemedicine as an option for patient care," McGreaham said. The real benefit, however, may be the ability of physicians anywhere in the system to quickly access a patient's lab or X-ray reports electronically. "We have made great strides in getting that done," he said.

For all its technological virtuosity, telemedicine may have a built-in limitation: Doctors already have their hands full with their regular practice.

"The challenge is, if you are a doctor in Traverse City and you have a full day of seeing patients here, and we are having challenges recruiting people, we don't have any excess capacity with our doctors for telemedicine."

Rx for the shortage?

Still, McGreaham says, the supply of new physicians could soon rise. The expansion of MSU's College of Human Medicine in Grand Rapids may improve the situation. So could other potential medical schools at Oakland University and Western Michigan University or elsewhere. Expansions are also underway at osteopathic schools.

Existing programs will play a role, too. Munson has a family practice residency program that graduates five residents per year. Most of them practice in rural areas, and about half remain in northern Michigan. The hospital also helps to oversee the training of five third- and five fourth-year students from MSU's College of Osteopathic Medicine.

According to Creamer of Michigan Health Workforce Development, that's the right idea. "If physicians train here, they are more likely to stay here." BN

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