New Jersey facing doctor shortage

Wednesday, January 27, 2010
By Jessica Beym, Gloucester County Times

CAMDEN - Imagine spending more time in the family doctor's waiting room with a sick kid on your lap. Or waiting hours in the emergency room to have a broken arm set in a cast.

It's a grim reality that could play out over the next decade as New Jersey is facing a shortage of about 2,800 doctors by the year 2020, according to the results of a study released Tuesday by the New Jersey Council of Teaching Hospitals.

Medical professionals from throughout the state gathered at Cooper University Hospital here to hear the results of the year-long study that evaluated the needs, identified barriers and recommended strategies to overcome the shortage of doctors.

John Sheridan, president and CEO of Cooper University Hospital, said the picture they painted wasn't meant to scare the public or overdramatize the issue. Rather, it lays the groundwork for what needs to be done.

"Our findings... are a wakeup call for public policy makers," said J. Richard Goldstein, president and CEO of NJ Council of Teaching Hospitals.

The council's task force used a forecasting model and considered a range of variables like the potential for national health care reform, the state's economic growth and the number of people who could become insured between now and 2020.

As of 2008, the state had 22,410 total physicians, and expects that number to increase by slightly less than 2,287 by 2020.

The projected shortfall is 2,835 doctors - 1,006 which will be needed in primary care, and 1,829 specialists. They anticipate shortages in almost every area, such as pediatrics, family medicine, anesthesiology, cardiovascular diseases and orthopedic surgery. The only area that won't have a shortage is emergency
medicine.

"A physician shortage crisis is right around the corner in New Jersey if we do not take immediate steps to change the course," said Goldstein.

"It can be done," he added. But it will take a collaboration of the state's medical school, hospitals that provide graduate medical educations, and lawmakers on both the state and federal level, Goldstein said. A number of factors are contributing to the projected shortfall, explained Deborah Briggs, vice president of health policy and advocacy for the council.

The medical colleges in New Jersey receive thousands more applicants than they have seats for. The University of Medicine and Dentistry of New Jersey in Stratford admitted 135 students in August out of about 4,000 applications, for example. Even with Cooper Hospitals partnership with Rowan University to create a new four-year allopathic medical school in Camden, that will only scratch the surface, Sheridan said.

Cooper which provides postgraduate training for doctors, is being stretched financially to accommodate those residencies, Sheridan said.

The hospital receives federal funding to educate only 203 of its 270 resident doctors, with the balance funded by the hospital and patient revenue. At most, they could only handle about 30 more, he said. Statewide, there are 2,600 training slots for physicians.

The largest issue is that New Jersey faces a lot of competition.

"Currently, almost 50 percent of the physicians we do graduate leave the state for more education or to practice," Briggs said.

Those who leave often don't return here to work because they establish connections in those hospital, Briggs said.

Enticing them to come back, or even bringing in out-of-state doctors, is extremely difficult because of what doctors have described to be a "hostile" work environment for them in New Jersey.

Briggs said the Garden State ranks the third-worst in terms of desirable locations for physicians, with only Pennsylvania and Florida being less desirable.

A survey of more than 800 doctors who left New Jersey revealed that the top three reasons they fled were proximity to their spouse, salary and economic costs such as the cost of living, business tax, and liability or malpractice issues.

"We haven't scored high at this point, however there is hope," Briggs said, adding that Texas once wasn't a desirable state for doctors to work but they have since improved.

The council recommended five major goals to turn around New Jersey's own climate for physicians - most of which center around finding more funding to educate students during med school and at the postgraduate level, and to provide better incentives for them to stay here. Reform is also a major issue.

The goals are:

• Pursue federal reforms to address problems in (General Medical Education) funding, administrative processes an regulatory oversight.
• Create the "Center for Medical and Health Workforce Planning" to continue monitoring, forecasting, predicting and refining recommendations
• Align goals and incentives between the medical schools, teaching hospitals and the state. This includes targeting and enrolling students who will more likely to practice in the state and giving incentive grants to schools and hospitals to reward retention of graduates.
• Enhance funding for medical education and postgraduate residency programs
• Expand retention and recruitment initiatives to encourage physicians to enter, remain in, or return to practice in New Jersey. That includes the creation of a fellowship-training and recruitment fund to bring in grads from other states, expanding the loan redemption program to target specialties with the biggest shortages, and establishing a tax forgiveness program, practice subsidy fund and mortgage assistance program for new physicians.