Rural Maryland Warned About Doctor Shortage; Reforms Urged

July 28, 2008

Maryland’s medical establishment is repeating its dire warnings about doctor shortages in rural areas as two government panels pondering the problem prepare recommendations to the governor and the 2009 General Assembly.

Earlier this month at the Rocky Gap resort near Cumberland, local hospital officials and physicians held a forum on the Maryland Physician Workforce Study, a report the Maryland Hospital Association and MedChi, the Maryland state medical society, released in January.

The study concludes that a shortage of doctors in rural Maryland is likely to worsen significantly by 2015 as older physicians retire and new ones choose to practice elsewhere.

“It’s very worrisome that only about 25 percent of our physicians are saying they want to stay here,” said Dr. Robert Barish, vice dean for clinical affairs at the University of Maryland medical school and chairman of the study’s steering committee. “In part, the No. 1 factor among residents right now is they want to be close to home.”

The report recommends legislative remedies including higher physician reimbursement rates by insurers, medical malpractice reforms and a state loan-forgiveness program to attract young physicians to regions most in need.

Nancy Fiedler, spokeswoman for the Maryland Hospital Association, said MedChi is holding a series of regional meetings to present the study’s findings to local physicians and community leaders. She said others are planned in Howard or Anne Arundel in September and on the Eastern Shore in October. Southern Maryland had one last spring.

Speakers at the Allegany County forum warned that the rural doctor shortage is especially hard on poor and elderly residents.

“When you look at the physician supply, the people who are the most affected are those who are most in need,” said Dr. Thomas Chappell, a Cumberland internal medicine physician and past president of the Allegany County Medical Society.

Barry Ronan, president and CEO of the Western Maryland Health System, said his hospital is recruiting the same doctors sought by those in Boston, Chicago and New York. He said WMHS recently ended a six-year search by hiring a gastroenterologist who had about 500 openings from which to choose.

The report says the doctor shortage will be felt most acutely in crowded emergency rooms that rely on scarce specialists willing to work on call. The study urges medical and elected leaders to take “bold steps” to attract and keep clinicians but it includes no price tag for nearly a dozen suggested actions.

Southern Maryland, with “critical shortages” in 25 of 30 physician categories, or 83 percent, will be hit hardest, the report says. Western Maryland, at 67 percent, and the Eastern Shore, at 60 percent, are close behind.

In the national capital region, encompassing Montgomery and Prince George’s counties, one in three specialists is older than 60, presaging a surge of retirements. Those counties already have fewer general surgery physicians and residents per 100,000 people than any area in the state but southern Maryland, according to the report.

Only central Maryland, encompassing Baltimore city and Baltimore, Carroll, Harford, Howard and Anne Arundel counties, is above the U.S. average of 269 active doctors per 100,000 residents, the study found.

Dr. Ruth Dwyer, a Washington County pediatrician, said she opened her practice 10 years ago with three pediatricians and a nurse practitioner and has retained just one of the doctors. She said she has searched four times in 10 years for another doctor “but their financial expectations are beyond what we can afford.”

Beside longer patient waits for appointments, the situation produces “wear and tear on doctors,” who are tired, Dwyer said.

Two panels — the Governor’s Task Force on Health Care Access and Reimbursement, and the Task Force to Review Physician Shortages in Rural Areas — are developing recommendations to address the problem. Both will submit reports to the governor and the General Assembly by Dec. 1, said Karen Black, a spokeswoman for the state Department of Health and Mental Hygiene.


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