States Struggle to Keep Doctors Home

After just moving to San Diego, I went to lunch in a crowded La Jolla restaurant with a friend, and he quickly exclaimed, "All those Zonies."

Zonies?

Arizona residents who escape the heat and go to San Diego for its nice balmy weather; that's why the restaurant was so packed, he said.

Our little exchange about Arizonans was carried out in good humor. It was the late 1980s and Arizona's population was beginning to escalate. Yet there was little doubt once the Zonies ended their vacations in California, that they would leave, and our restaurants would be less crowded, as well as the beaches and everything else.

The population growth continues in Arizona, especially among older baby boomers. In the meantime, there are increasing questions about who is going to care for their patient population, according to a 2005 study on physician workforce by the Arizona State University Center for Health Information recently released.

From 1994 to 2004, the physician workforce in Arizona increased from 8,026 to 12,024, at a rate higher than the overall population increase in the state at that time. But the ratio of physicians to population in Arizona was 207 per 100,000 in 2004 — considerably below the national average, which was 283 per 100,000.

And the estimated 2010 national ratio is about 299 physicians per 100,000, and 213 per 100,000 for Arizona, according to The Arizona Republic. That gap is still significant, William G. Johnson, PhD, director of the center and professor of ASU's biomedical information and co-author of the report, said.

The Republic's story about the study, has gathered a lot of attention. But the state isn't alone in trying to keep physicians home, that's for sure. I checked the U.S. Census Bureau, http://www.census.gov/compendia/statab/which noted the ratio of physicians to populace as of 2007. States having a lower number of physicians per 100,000 than Arizona included:

• Idaho, 169
• Oklahoma, 173
• Mississippi, 178
• Iowa, 189
• Arkansas, 203
• Utah, 208
• Texas, 214

One of the biggest issues for some states is that they are not cultivating their own physicians. That's specifically Arizona's problem, according to the study.

Only 10% of the physicians practicing in Arizona attended medical school in Arizona and only one-third of Arizona physicians completed residency training in the state.

"With the decreasing popularity of family medicine and decreased number of family medicine residency positions in the state, it is unlikely that medical education in Arizona can expand to a level where even one-half of the practicing physicians will have attended medical school in Arizona," the study says. "Therefore, Arizona will continue to rely on the in-migration of physicians to maintain its physician workforce."

J. Fred Ralston, Jr., MD, FACP, president of the American College of Physicians, said states are encouraged to do what they can to maintain physicians. "Funding for training programs or scholarships for people to practice in some areas has shown success in some places," Ralston explained. "But realistically, with most of the states facing budget shortfalls, I'm not sure they have the financial resources to commit to that. Now you have a perfect storm of having shortages in some specialty areas, exactly the time the baby boomers are requiring more doctors."

Nationwide, physicians will "presumably increase competition among the states for the pool of physicians," according to the Arizona report. "Arizona faces a more difficult problem than other states because its population is increasing."

In Idaho, where the physician-population ratio is worse than Arizona, 169 per 100,000, the lack of physicians is troubling, according to Susie Pouliot, CEO of the Idaho Medical Association, which represents 2,000 physicians, about 70% of the state's total.

"Concern is not too strong a word," said Pouliot. "Among our priorities is ensuring a physician work force now, and in the future." The University of Idaho is a member of WWAMI, the University of Washington School of Medicine regional medical education program, and Idaho students have training outside the state. As a result, the IMA is working to initiate a variety of medical educational support programs, expand resident training, and offer increased support for existing workforce to encourage future Idaho physicians to stay home, Pouliot said.

Thomas Striegel, an emergency department resident at the Maricopa Medical Center, told the Republic he had mixed feelings leaving Arizona to continue his practice at his family home in Iowa.

But Iowa has 189 nurses and doctors per 100,000 population, the census figures show, also less than Arizona. Iowa may need him more than Arizona.