FL Teaching Hospitals Eye Specialist Shortage

A projected 7% shortfall of primary care physicians by 2025 and a 19% shortfall of specialists is the result of a "misallocation" of places where graduate medical residency slots should be, says a Florida hospital CEO and executive at the Teaching Hospital Council of Florida.

Florida teaching and safety net hospitals are warning of a looming shortage of 7,000 physicians in the coming decade unless more medical residency programs are created, a new report shows.

While there is a general sense that Florida, and just about every other state, faces a physician shortage, the study commissioned by the Teaching Hospital Council of Florida and the Safety Net Hospital Alliance of Florida details a gloomy forecast for the Sunshine State.

The projections in the report conducted by IHS Global include a 7% shortfall of primary care physicians by 2025 under the current scenario. The estimate jumps to a 19% shortfall of physician specialists in 19 specialties, with the largest areas of need in psychiatry, general surgery, rheumatology, and thoracic surgery.

"In Florida, the shortage is caused by a combination of things," says Jim Burkhart, president and CEO of Tampa General Hospital, and vice-chair of the Teaching Hospital Council of Florida.

"We just passed New York as the third most-populous state. The number I heard today was that Florida is growing at the rate of 800 new residents per day. But we are 42nd in the number of residency slots we have per capita. That is a formula for disaster."

"The population is aging for all of us," says Burkhart, "so we are going to need more physicians in general. That means the physicians are aging, so many of them are going to age out and leave, so we have to replace them. So, add all that up and you can see why there is an exponential effect on the shortage of physicians in the State of Florida."

The Teaching Hospital/Safety Net Hospital study estimates that Florida would need to create and fill 13,568 residency positions to fully resolve the physician shortage by 2025. That would be about 1,360 new residency slots a year for the next decade.

The study also shows that Florida will face a 19% shortfall of physician specialists needed in 2025, compared with an overall 7% shortage of physicians. Shortfalls will exist to varying degrees across all regions, with the Panhandle and Southwest Florida having the most severe shortages of doctors in endocrinology, rheumatology, hematology, and other non-primary care areas.

The state's physician shortage has the attention of Gov. Rick Scott (R), a former healthcare executive, who proposed $80 million in 2013 to fund new Medicaid residency programs. In his latest budget, the governor has proposed increasing the funding by another $7.5 million.

Burkhart says the solution to Florida's physician shortages will involve a coordinated national effort, including shifting residency slots among the states. Many reports have noted that an overwhelming number of new physicians establish their practice close to their residency.

"At some point in time, the federal government is going to need to address the misallocation that occurs with the existing formulas that are in place for where there graduate medical residency slots should be," he says.

"These residencies are disproportionately in the Northeast. People are leaving the Northeast. We just passed New York as the third most-populous state. New York gets $2 billion for graduate medical education. We get $200-and-something-million for graduate medical education. It's a problem and that misallocation needs to be addressed."

While much of the rhetoric around the physician shortage on the national stage has concentrated on the need for more primary care physicians to coordinate population health, Burkhart says policymakers should not ignore the need for specialists.

"It's not either/or. We are proposing that we do both," he says. "The primary care shortage is a little easier to address simply because you can train primary care physicians in a much broader number of facilities than specialists. You have to have highly specialized places to train thoracic surgeons or rheumatologists."

In addition, Burkhart says, the effect of the primary care shortage is more-easily mitigated with the use of physician assistants and nurse practitioners, and the growing popularity of retail-based urgent care and primary care medical services.

Tim Dall, a managing director at HIS and the author of the study, says the scope of practice of primary care physicians has to be weighed against the needs of the population.

"At the end of the day, if the patient has cancer or some other chronic condition, there is only so much a primary care physician can do," he says. "A primary care physician can help manage a disease, but you need a specialist to be involved. When the patient needs surgery there has to be a surgeon."