hill country observerThe independent newspaper of eastern New York, southwestern Vermont and the Berkshires

 

News & Issues September 2022

 

Seeking a few good doctors

Shortage of physicians puts crimp on medical care in a graying region

 

Dr. Sean Bain, left, the chief medical officer of Glens Falls Hospital, D. Geoffrey Serfilippi, co-director of the hospital’s Intensive Care Unit, and Emily Luedders, a registered nurse in the ICU. photo courtesy of Glens Falls Hospital

 

Dr. Sean Bain, left, the chief medical officer of Glens Falls Hospital, D. Geoffrey Serfilippi, co-director of the hospital’s Intensive Care Unit, and Emily Luedders, a registered nurse in the ICU. photo courtesy of Glens Falls Hospital

 

By MAURY THOMPSON
Contributing writer

RUTLAND, Vt.


When a local ear, nose and throat specialist retired 10 years ago, officials at Rutland Regional Medical Center set out to recruit a replacement.


A decade later, they are still trying without success. And now they have a second open position for an ENT specialist, said Tom Frank, the hospital’s vice president of medical group operations.
The case is emblematic of the physician shortages that experts say have been hampering the provision of health care in much of upstate New York and northern New England for more than a decade. And the problem is expected to become more acute in the next few years as more area doctors age and retire along with the general population.


The region’s increasingly inadequate supply of doctors is partly a function of a well-documented national trend. By 2034, the United States will have an estimated shortage of between 37,000 and 124,000 physicians, according to the Association of American Medical Colleges. This includes shortages of between 17,000 and 48,000 primary care physicians — and between 21,000 and 77,000 specialists.


“It’s a big deal,” said Gary Fitzgerald, president and chief executive officer of Iroquois Healthcare Association, a trade group for upstate New York hospitals. “It’s getting worse.”


Local health care officials say nationwide shortages are making it much harder to recruit doctors to rural areas and small cities, especially those that are considered beyond the orbit of major metropolitan centers.


In New York, portions of Warren, Washington, Saratoga, Rensselaer and Columbia counties now are designated as physician shortage areas, according to Rural Health Information Hub, an online industry news site. So have portions of Bennington and Rutland counties in Vermont and Berkshire County in Massachusetts.


Although the lack of primary care physicians has drawn attention for years, the shortage of doctors has spread over the past decade to many specialized areas of practice. Psychiatry and emergency medicine are among the specialties with critical shortages, not just in New York and Vermont, but nationally.


“In terms of the most difficult areas for recruitment, primary care is the most challenging,” said Ray Agnew, the vice president for hospital and community relations at Glens Falls Hospital. “However, we are finding that medical and surgical specialists are becoming more difficult to find as well.”

 

Reducing access to care
Physician shortages are making it difficult to get appointments, particularly in outlying areas, and in one case a community health center affiliated with Glens Falls Hospital reduced its hours of service because of staffing issues.


A cutback in hours several years ago at the Salem Family Health Center in Washington County left patients temporarily traveling 10 miles or more to health centers in Greenwich, Granville or Cambridge for care.


“If your doctor retires and you can’t find one, then you have to go to the next community over, and that can be a haul,” particularly for patients that have transportation issues, Fitzgerald said.
In another national trend, some physicians are scheduling appointments every 15 minutes instead of every 30 minutes, leading to concern from consumer groups about the quality of care.
“Doctor shortages affect access — access to care,” explained Frank, the Rutland hospital vice president.


The shortages can have a cascading effect, he said. The Rutland hospital’s physician practices already have seen an increase in patients from outside its core service area because of the shortage of doctors in more rural parts of the state.


“The demand for our services is growing, not shrinking,” Frank said.
In the Association of American Medical College’s 2019 patient survey, 35 percent of respondents said that they or people they know had experienced difficulty finding a doctor within the previous two years, an increase of 10 percentage points since the group’s 2015 survey.


The widening shortages are a function of increased demand for medical care at the same time that more physicians are retiring.


Another factor is the increased number of people that now have health insurance, and seek out services they might have avoided previously, as a result of the 2010 Affordable Care Act, more commonly known as Obamacare.

 

More needs as a nation ages
The overall number of physicians actually is increasing nationally, but not fast enough to keep up with increased demand.


There were slightly more than 1 million licensed physicians in the United States in 2020, the most recent statistics available, a 19.8 percent increase from 850,000 in 2010, according to the American Medical Association.


But in the years ahead, as the baby boomer generation ages, the national population of those 65 and older is projected to increase at four times the rate of the overall population.


At the same time, about one-third of current physicians nationally will reach retirement age in the next five years, and 40 percent will do so by 2031.


In a recent survey, about 20 percent of physicians said they are likely to leave their current jobs within the next two years, and 30 percent said they are likely to cut back on working hours.
Agnew said the average age of physicians at Glens Falls Hospital is 49.

 

Thomas Frank, the vice president of medical group operations at Rutland Regional Medical Center, and Sarah McCuin, the hospital’s medical staff services and physician relations specialist, are working to address a shortage of physicians in certain specialities at the hospital. Joan K. Lentini photo

 

Thomas Frank, the vice president of medical group operations at Rutland Regional Medical Center, and Sarah McCuin, the hospital’s medical staff services and physician relations specialist, are working to address a shortage of physicians in certain specialities at the hospital. Joan K. Lentini photo


At Rutland Regional Medical Center, the average age is probably in the mid-40s, Frank said.
The stresses of the medical profession, which have grown stronger in the Covid era, may prompt some to retire early, the medical education association suggested.


Nationally, more than 3,200 physicians left jobs in direct care because of burnout between January 2019 and fall of 2021, according to the American Medical Association. The share of physicians who worked full time decreased from 84.2 percent to 80.7 percent during the same period.


Psychiatrists, in particular, reported increased fatigue from treating patients during the pandemic.

 

Priced out of the market
Because the physician shortage is national in scope, it has created increased competition for wages.


“What we find is that we are getting priced of the range,” Frank said. “You’ve really got to turn over every rock if you want to find a dedicated physician.”


This competition also is placing more pressure on the bottom lines of hospitals and health centers.


In Vermont, rates that insurance companies pay are set by a state commission, so hospitals can’t simply raise prices in order to pay higher wages.


“We do not have the authority to raise our rates,” Frank said.
In New York, rates are negotiated with insurance companies, but insurance companies are not inclined to pay more for services, Fitzgerald explained.


Sometimes, he said, hospitals wind up having to pay more in wages to doctors than they collect in revenue from patients’ office visits. That, he added, “is not good financial policy.”


Hospitals and health centers have reacted, in part, by relying more on physician assistants and nurse practitioners, but there are shortages in those fields too.


Physician assistants and nurse practitioners now often get advanced training to specialize in specific types of care, which eases the shortage of physician specialists — but exacerbates shortages in primary care, Frank said.


There also are shortages in nursing and other medical support fields, which can make it difficult to provide services even if physicians can be hired.


“Staffing shortages are critical across the healthcare landscape nationally — particularly nurses, technical specialists such as radiation techs and surgical techs, and physicians,” said Agnew, the Glens Falls Hospital vice president.


Last year, Hudson Headwaters Health Network, headquartered in Queensbury, established a mobile health van that takes primary care to underserved rural communities in Warren and Washington counties.


Hospitals and health centers are making increased use of telemedicine medical consultations using Internet video-conferencing services.

 

A good place to live
Locally, hospital executives say the region’s quality of life provides one of their best recruitment tools.


“We believe we live in one of the most beautiful places in the country, with amazing lifestyle choices — a great selling point for potential candidates,” Agnew said.


Frank said Rutland Regional Medical Center focuses on recruiting physicians who are married with young children and want to live in a wholesome community that is close to ski centers. But it’s virtually impossible recruit a single physician just out of medical school to come to Vermont, he said.


Glens Falls Hospital focuses on offering residencies to medical students to establish connections for future employment.


“We begin our recruitment process early on, when those in medical school are reaching the final year of residency,” Agnew said. “That allows us to make advance offers and then bring them on board as soon as they have completed their residency. Candidates today are seeking a work-life balance, requesting things like a four-day work week, which includes their practice and on-call duties.”


Glens Falls Hospital has recruited 18 physicians, physician assistants and nurse practitioners so far this year, he said.

 

Legislating for a cure
Industry leaders and the region’s state and federal lawmakers have offered various proposals in recent months to help alleviate staffing shortages in the medical professions.


In New York, the Iroquois Healthcare Association is urging the Legislature to resume funding for a program the trade group operated for about three years to introduce New York City medical students to career opportunities upstate.


“Many of these residents and medical students never come north of the Tappan Zee Bridge,” he said.


The trade group would fly New York City medical students into Syracuse, and then take them via motorcoach on a tour of upstate hospitals and the communities those hospitals serve, similar to the concept of a “fam tour,” short for familiarization, in tourism marketing.


U.S. Rep. Elise Stefanik, R-Schuylerville, has proposed allowing foreign medical students to remain in the United States to practice medicine after completing their education. Currently, these students are required under their J-1 educational visas to return to their home countries for two years after training. Stefanik wants an exemption to that requirement.


Assemblywoman Carrie Woerner, D-Round Lake, introduced legislation to require health insurance companies to cover telemedicine physician visits and to pay the same rates as a traditional office visit.


Democratic state Senate candidate Andrea Smyth of Troy has proposed that New York return to a system in which the state would set rates that health insurance companies pay for certain services, such as mental health, vision and dental, in which there are shortages of providers. Opposition from the insurance industry, however, would likely make that proposal a long shot.
The state previously set all health insurance reimbursement rates until 1996, when then Gov. George Pataki, a Republican, ended the practice and allowed insurance companies to negotiate rates directly with hospitals and physicians.


The move was intended to increase competition in the insurance industry, which, in theory, would reduce insurance premiums.


Smyth, who is running against Assemblyman Jake Ashby, R-Castleton, for an open seat in the new 43rd Senate District, was a health care and family policy analyst and advocate for about 30 years before recently retiring.