The Connecticut physician shortage is not approaching: it is already here. How nice of the Connecticut Trial Lawyers Association to decide that patient access to medical care is worthy of its attention. Don’t be distracted by its habit of playing fast and loose with research. I’m not.
Rather than boring you with a dissertation on the differences between primary and secondary data and the limits of secondary data (in the 2008 University of Connecticut report cited by Neil Ferstand), the Connecticut State Medical Society stands by the findings of its 2008 Physician Workforce Survey (Link to full report and tables) and its 2009 Primary Care Survey (Link to full report) and the upfront discussion of the limitations of that research. That said, let’s talk about Connecticut’s physician shortage and why it exists today.
I have just joined the more than 45 percent of Connecticut physicians who are age 50 or above. The American Medical Association tracks that as a benchmark age, because that’s when studies show physicians start thinking about reducing their hours and how long they’ll continue practicing full-time. The cavalry isn’t coming to replace us. In 2011, not one of the 14 residents and interns from the Yale School of Medicine who chose to remain here intended to practice in primary care; 29 from the University of Connecticut’s graduating class stayed – 8 in primary care. That’s just slightly better than the 2009 Journal of the American Medical Association study that showed 2% of the graduates of U.S. medical schools entered residency in primary care.
In fact, the Association of American Medical Colleges and the Council on Graduate Medical Education are just two of the many organizations projecting patients will be facing a national shortage of physicians in the not-distant future. AAMC estimates the deficit will reach 63,000 physicians in all specialties just over two years from now. (Link to AAMC research) A host of national medical specialty organizations, from the American College of Physicians to the American College of Emergency Physicians, has similar projections.
We have all chosen to live and work in Connecticut – why aren’t our young physicians? The majority of Connecticut’s physician practices still have between one and four physicians. They are small businesses facing the same everyday pressures as all other small business across our state. But their financial projections are far less rosy from the outset. After leaving medical school and residency with an average of more than $150,000 of student loan debt, before seeing a single patient, one must pay Connecticut medical liability insurance premiums that are among the highest in the country. Then, unlike the copy shop around the corner or the diner up the street, a solo physician has next to no ability to set the prices he or she will be paid. Physicians are barred from negotiating collectively under outdated federal antitrust laws. The doctor is David up against Goliath negotiating contracts with insurance companies that determine what he gets in “reimbursement” for each and every service he provides. We’re not talking about the expensive medical testing done in hospitals, either. Some physicians would love to be able to compete with hospitals for that business, but the State maintains a cumbersome and excruciating Certificate of Need process that costs a physician upwards of $30,000 just to apply before a physician can invest tens, or even hundreds of thousands of dollars more on the high-tech equipment they want to buy. All talk of capital investment in electronic medical records aside, there are scores of small practices that still don’t have Internet connections.
At the same time, Connecticut has an above-average percentage of Medicare recipients, according to the AMA. Congress has enacted more than a dozen short-term patches to stave off Medicare cuts that directly affect the bottom line in my cardiology practice and hundreds of other medical practices across the state. No business can stay afloat when it suddenly faces revenue cuts of 20-30% for a significant percentage of its business. I’ve seen practices around Connecticut take out lines of credit to be able to make payroll while Congress was making up its mind what to do. That’s no way to stay in business. What’s worse: these cuts directly affect access to medical care for more than 563,000 Medicare patients and 51,000 active and retired military personnel and their families who are caught in the middle.
The Connecticut physician shortage is significant enough for Quinnipiac University to be adding a third medical school to our landscape, one focused on primary care and intending to provide incentives to students who stay here to practice medicine. Universities don’t create medical schools for short-term problems. It takes years to make a new physician; this investment won’t start paying off for awhile. But in the meantime, CSMS proposed last session, and the state Senate unanimously passed, legislation to create “targeted health areas” that would help make our state, and in particular its underserved areas, more attractive to physicians.
There are 49 other states that also need more physicians to meet their needs. New Jersey, Pennsylvania, New York and Massachusetts all indicate physician shortages. It’s time Connecticut did something to make itself attractive to physicians. Because my colleagues and I are getting grayer by the day and patients are counting on action. We hope we can count on the trial bar to exercise its newfound concern for patient access to medical care by advocating for legislation that makes Connecticut more hospitable for young physicians, such as addressing our medical liability crisis and creating incentives that help medical practices stay open.
John A. Foley, MD, is the president of the Connecticut State Medical Society and the New London County Medical Association.