There are a number of forces driving changes in the healthcare industry that have an impact on physician recruiting. These include the implementation of the Patient Protection and Affordable Care Act, the upward trend in physicians’ work-life balance preferences, and the increasing patient base of newly insured and aging baby boomers. Below we explore the trends that are having the greatest impact on physician recruitment:
Physician Shortage and State Suffering the Most
According to estimates by the Association of American Medical Colleges, there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025. The Office of the Inspector General has cited physician scarcities in various specialties including: obstetrics, family practice, general surgery, neurosurgery, orthopedics, urology, otolaryngology, cardiology, gastroenterology, neurology and oncology.
Samuel Weigley, Alexander E.M. Hess and Michael B. Sauter tabulated data from the American Association of Medical Colleges’ State Physician Workbook Data Book. According to their results, the states suffering most from the physician shortage include Georgia, Wyoming, Oklahoma, Nevada, Alabama, Texas, Idaho, Utah, Arkansas and Mississippi.
- Georgia has 20 physicians per residency or fellowship for every 100,000 patients, falling below the national average of 35.
- Wyoming employed 1,000 active physicians in 2010, with only two accredited residency programs of 39 doctors.
- Oklahoma has 20 residents per 100,000 patients, and according to New England Journal of Medicine, has the least accessible healthcare.
- In Nevada, the current physician-to-patient ratio is 178.1 doctors for every 100,000 people. This is in contrast to a national average of 219.5 doctors per 100,000 people. The state also has the smallest number of residency programs in the West.
- Alabama has only 22 medical students and 25 residents per 100,000 patients, and only two accredited medical schools.
- Texas is having difficulty recruiting physicians in 36 out of 40 specialties. A recently passed law now requires international medical graduates, which account for a quarter of Texas’ physician staff, to work in underserved areas for three years to get a license.
- Idaho does not have an accredited medical school and operates with 4 residents per 100,000 people.
- Utah’s only medical school had to trim enrollment by 20 students per year due to federal budget cuts, despite a steady increase in population.
- Arkansas only has one medical school, where just about half of its graduates continuing to practice within the state.
- Meanwhile Mississippi only has 159.4 physicians per 100,000 patients and 20 medical students per 100,000 people.
Some states have taken steps to address these issues. State medical schools in Georgia are increasing their enrollment of students by 50%. The University of Alabama School of Medicine will open a new regional campus to train more physicians. In 2011, TexasTech introduced a three-year medical program for those who wanted to go into healthcare, which includes first-year scholarship assistance. Rural healthcare organizations in Mississippi are offering incentives for physicians to relocate in those areas, while the Appalachian Regional Commission sponsored visa waiver programs to recruit international medical graduates.
Best States to Practice
Medscape Medical News analyzed physician density, malpractice coverage, insurance competition, medical board activity, insurance mix, income taxes, and cost of living in all 50 US states and the District of Columbia and came up with a list of the best — and the worst — states to practice in each region.
- Southwest and South Central: Arizona, Arkansas, Colorado, Nevada, New Mexico, Oklahoma, Texas, Utah
- West and Northwest: Alaska, California, Hawaii, Idaho, Montana, Oregon, Washington, Wyoming
- Southeast: Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, South Carolina, Tennessee
- Mid-Atlantic: Delaware, District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, Virginia, West Virginia
- Great Lakes and North Central:Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin
- Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont
Aubrey Westgate of Physicians Practice reported Tennessee as one of best states to practice due to its entrepreneurial advantage, low cost of living and no state income tax, citing a successful, physician-owned mutual company which provides malpractice coverage to doctors. Wiley T. Robinson, president of Tennessee Medical Association, said, “A person straight out of training could easily find a job either A., being employed, or B., set up their own independent practice and be quite successful.” Meanwhile Virginia boasts of low cost of living compared to its neighbors Maryland and Delaware, low unemployment rate (6.3%) and over half of its population with employment health coverage. Virginia also has lower state income tax compared to other mid-Atlantic states.
New Hampshire has average cost of living, and 62% of its population has employment-sponsored coverage with only 10% not having health insurance. Malpractice insurance payments are higher compared to nearby states such as Maine and Vermont, but it doesn’t have sales or income tax and instead only charges 5% on dividends and interest. South Dakota on the other hand has low malpractice insurance costs and no state income tax. Physician median income is more than $247,000, while personal income grew by 6.2% in 2011. Of note is Sioux Falls, which has two hospital systems and a residency program.
Massachusetts, which implemented near-statewide health coverage, has the lowest uninsured rate in the US. Many doctors practice in the state, because they can generate more income from insured patients. Maryland, home to three medical schools, has a median income of $68,854, which is around $19,000 higher than the national average. This may be one of the reasons many physicians find it appealing to practice in the state.
In a recent survey conducted by the Archives of Internal Medicine, 45.8% of its physician respondents reported at least one symptom of burnout. Practicing medicine includes constant pressure and stress, and doctors work an average of 10 hours more weekly than US workers in other fields. According to the same survey, family and emergency physicians as well as internal medicine doctors are more affected, with ER physicians averaging at least three patients per hour.
To address work-life balance and patient safety, the Accreditation Council for Graduate Medical Education (ACGME) in states such as Philadelphia, Cleveland, Ohio and Chicago, Illinois have approved new regulation to reduce work hours for new medical graduates and residents. The new requirement, which had an impact on over 110,000 physicians, restricts first year residents to 16-hour shifts. Second year residents can only work continuously for up to 24 hours, and another four hours to refer patients to other doctors. In an 80-hour per week requirement, residents can still work up to 30 hours per shift. Before ACGME capped the working hour limit in 2003, physicians were working up to 120 hours a week. These changes appeal more to the younger generation of physicians who want to balance their medical career and personal interests or pursuits.
In addition, several medical schools have initiated steps to promote career flexibility among faculty members, scientists and physicians through recruitment and retention programs that emphasizes work-life balance, flexible call schedules and tenure extensions among others. The American Council on Education (ACE) and the Alfred P. Sloan Foundation recently honored five medical schools for excellence in promoting career flexibility, by awarding each a $250,000 grant for excellence in faculty career flexibility. “Our colleagues at the Association of American Medical Colleges note that the United States is facing a looming crisis: a serious doctor shortage,” said ACE Senior Vice President Gretchen M. Bataille. “If our medical schools aren’t retaining the right faculty, then that shortage will only be exacerbated. These seven institutions are taking bold steps to keep the best and brightest teachers, which helps attract future doctors.”
“Doctor Shortage Expected to Grow in S. Nevada,” Aaron Drawhorn, 8 News Now KLAS-TV, October 23, 2012.
“Medical Schools Make Strides on Work-Life Balance for Academic Physicians,” American Council on Education, October 3, 2012.
“Medscape’s Best Places to Practice,” Shelly Reese, Medscape, May 23, 2012.
“Nearly half of physicians struggle with burnout,” Carolyne Krupa, American Medical News, September 3, 2012.
“New doctors have shorter hours, better work-life balance,” Teresa Chin, Wall Street Journal, August 6, 2011.
“New rules prescribe shorter hours for young doctors,” Gregory Thomas, Philadelphia Inquirer, July 1, 2011.
“New Rx for Young Doctors: Shorter Work Day,” Shirley S. Wang, The Plain Dealer / cleveland.com, June 24, 2010.
“Rookie doctors to work shorter hours,” The Associated Press, September 29, 2010.
“States with the Fewest (and Most) Doctors,” Samuel Weigley, Alexander E.M. Hess and Michael B. Sauter, 24/7 Wall St., October 19, 2012.