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Physician shortage prompts regional solutions

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Dr. Christopher Newman is chief medical officer at Penn State Health St. Joseph, which is one of many hospitals challenged by a shortage of physicians. PHOTO/CHRISTOPHER HOLLAND
Dr. Christopher Newman is chief medical officer at Penn State Health St. Joseph, which is one of many hospitals challenged by a shortage of physicians. PHOTO/CHRISTOPHER HOLLAND

A tight physician labor market is spurring competition for talent and making recruiting a challenge, officials at local health networks said.

And the market may get worse before it gets better.

By 2030, the United States could see a shortage of between 42,600 and 121,300 physicians, which could impact patient care, according to a report earlier this year by the Association of American Medical Colleges.

The projected shortage includes both primary and specialty care, with specialty shortages expected to be particularly acute. Much of the increased demand for physicians comes from a growing and aging population, and the impending retirements of older physicians, the association said. The population of people 65 and over is expected to grow 50 percent by 2030.

“For every physician there are multiple jobs. It’s a very competitive market,” said Dr. Christopher Newman, vice president of medical affairs and chief medical officer at Penn State Health St. Joseph in Bern Township.

Penn State Health St. Joseph's medical staff includes about 400 employed and independent physicians.

The health system has hired 100 new physicians in the last two years and doubled its medical group to 200 clinicians. But, Newman said, “Locally, we’ve struggled in a few areas.”

Hospitalists – internal medicine doctors who manage hospitalized adult patients – are among the specialties that have been difficult recruit, he said.

Other high-demand medical specialties – such as neurology, anesthesiology, pulmonology, dermatology, psychiatry, urology and emergency medicine – can be difficult to fill, according to officials at local health networks.

A TEAM APPROACH

Jane Ferry, chief medical officer at Grand View Health in Sellersville, said even though many physicians prefer to work for hospital and health networks rather than in private practice, the tight labor market has made recruiting more competitive.

Ferry said Grand View, which employs about 70 physicians, has devised a solution by working with what it calls an integrated delivery network: It contracts with primary care physicians who are largely independent.

Grand View also takes a more team-based approach to health care than it did 10 years ago, relying on its 30 advanced practitioners, nurse practitioners and physician assistants.

“I think the nurse practitioners and physician assistants are helping to fill some of those challenges with physician shortages,” Ferry said.

Ferry said Grand View’s location in the Mid-Atlantic, its proximity to a large number of medical schools and training programs and its affiliation with Penn Medicine give it an advantage over hospital networks in the Midwest and rural areas.

“Having said that, it’s easier in an inner-city environment to fill slots than in the country, even Bucks County,” she said.

Competition is heating up in particular among the large health networks in the Greater Lehigh Valley, especially between St. Luke’s University Health Network and Lehigh Valley Health Network.

“We keep an eye on all that’s going on around us. It would be unwise not to,” Ferry said.

Grand View Hospital, a 200-bed community hospital, uses Penn Medicine as a backup partner for more complicated medical conditions and advanced treatments, known as tertiary care, such as heart transplants or proton beam therapy for cancer or experimental procedures.

“It also gives us a supply of physicians from Penn’s training programs,” Ferry said.

CREATING A PIPELINE

While medical schools have increased class sizes by nearly 30 percent since 2002, the medical college association believes a multi-pronged approach is necessary to ease the physician shortage, including legislation that would increase federal support for an additional 3,000 residency positions each year for the next five years.

In 2015, state and federal agencies spent more than $16.3 billion on graduate medical education, according to the U.S. Government Accountability Office.

Teaching hospitals in the region and those with medical schools use their residency slots as a pipeline to fill vacancies, as studies show more than 50 percent of residents stay in the region where they were trained.

Tower Health is partnering with Drexel University College of Medicine to build a new, four-year regional medical school near Reading Hospital in West Reading.

“Our affiliations with Drexel ... will help us address the projected physician shortages in our region, bring improved access and services to our patients and provide significant economic benefit to the entire Reading area,” said Clint Matthews, president and CEO of Tower Health.

St. Luke’s, meanwhile, plans to add 160 residents over a five-year period in psychiatry; dermatology; ear, nose and throat; emergency medicine; internal medicine; and family medicine.

Many of those residencies will be at St. Luke’s Anderson Campus in Bethlehem Township, where the $100 million Women and Babies Pavilion under construction will house an expanded graduate medical education program.

The new residencies will nearly double the number of residents and fellows to more than 400, the largest program in the Lehigh Valley.

St. Luke’s recently launched a new rural residency program at its Miners Campus in Coaldale, which, like rural areas across the country, is expected to be hit especially hard by the physician shortage.

“There are a lot of nuances to providing care in rural settings that require unique training and additional skills,” said Dr. Gregory Dobash of St. Luke’s Ashland Family Practice and site director of the accredited rural training program, one of 34 in the country and the only one in Pennsylvania.

Penn State Health St. Joseph was able to retain most of its residents in family practice after they graduated, Newman said.

GROWING DISSATISFACTION

The projected shortage comes at a time when a recent study indicated physicians are increasingly dissatisfied with the medical profession, which could have implications for the physician workforce.

Geneia, a Harrisburg-based health care analytics company, conducted a survey of 300 full-time physicians nationwide and found 66 percent said the challenges of practicing medicine in today’s environment have caused them to consider career options outside of clinical practice, an 11 percent increase compared to its 2015 study.

And 80 percent said they are personally at risk for burnout at some point in their career.

“It’s worrisome that the trend is worsening,” said Heather Lavoie, president of Geneia, who called burnout among physicians at “epidemic levels.”

“If people are unhappy their productivity will be lower. Even though they may still be in the field practicing medicine, their effectiveness with patients may be lower and patient load may be impacted,” Lavoie said.

She said physician discontent may have a “downstream effect” that could affect patient health and safety.

Lavoie said the health care industry, particularly companies that design or manage electronic health records, needs to work together to help restore the joy of medicine to physicians.

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