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Trends Toward Greater Doctor Shortage Worry State Legislators

Doctors, medical students propose student loan forgiveness, tort reform to help solve problem

New Jersey policymakers looking to address a looming shortage of doctors in the state need to act quickly, as the problem appears to be getting worse and more quickly than predicted.

More of the state’s medical residents are planning to leave the state to practice elsewhere. The amount of student debt these new doctors are carrying is growing steadily, forcing those who are entering lower-paying practice areas like family practice or obstetrics/gynecology to consider relocating to lower-cost states with better reimbursement rates.

At the same time, the state is expected to need more primary care doctors to serve the additional insured patients due to the Affordable Care Act.

Both legislators and doctors have proposals for reducing the looming shortage of physicians in the state, ranging from enhancing New Jersey’s medical student loan redemption program to paying for state hospitals to launch residency programs.

“We have to have an incentive to keep them in the state,” state Sen. Robert W. Singer (R-Monmouth and Ocean) said of young doctors. “We’re seeing that the older doctors are retiring and new doctors are not coming into the field to replace them. It’s a growing concern.”

That concern is borne out by a recently completed survey of New Jersey’s medical residents conducted by the New Jersey Council of Teaching Hospitals. The survey found that only 34 percent of medical residents planned to stay in the state in 2013, compared with 39 percent in 2012. In addition, 44 percent of residents have student debt exceeding $200,000, up from 38 percent the previous year. For residents planning to specialize in primary care, the debt load is even higher, with 48 percent reporting $200,000 or more in debt.

In 2010, the council projected that the state would have a shortage of more than 2,800 primary-care doctors by 2020. Council President and Chief Executive Officer Deborah S. Briggs said that gap is worsening. She added that the projection depended upon most internal-medicine residents choosing to practice primary care, but recent surveys point toward nearly 80 percent of these residents choosing other specialties.

While the 2010 study gained notice, it’s quieted down “and there’s not the action that we need,” Briggs said, adding that the ACA may be drawing attention to the shortage issue again.

Singer has introduced a bill, S-162, that would create a new program to forgive medical school loans for doctors who work in the state for 10 years. It could potentially augment or replace an existing program that provides for up to $120,000 in loan redemption an existing program that provides up to $120,000 in loan forgiveness. Singer said the current program is too limited in the geographic areas where doctors must practice in order to be eligible for the loan redemptions.

Medical Society of New Jersey Chief Operating Officer Mishael Azam said her organization – the state’s largest doctors’ group – is encouraged by Singer’s plans, but wants to ensure that the program is funded.

“There is no funding source in the bill and we want to make sure that students know there is a constant and available funding source that they know they can take advantage of, so that they know the funding is there through their 10-year commitment,” Azam said.

Singer said the bill, recently released by the Senate Education Committee by a 4-1 vote, is unlikely to pass this year, but will be a priority for him in 2014.

Claudine Leone of the New Jersey Academy of Family Physicians said private medical practices in the communities that could benefit most from having additional doctors aren’t hiring. That’s because these practices can’t afford the salary of entry-level doctors. Singer suggested the state could offer a tax credit to practices in underserved areas to offset some of the cost of hiring new doctors.

“The concern is that the existing practices don’t have the cash flow to bring on another doctor at that rate and there might have to have some type of incentive for them to do that,” Singer said.

While there appears to be bipartisan support for the measure, it’s not universally supported. Sen. Michael J. Doherty (R-Hunterdon, Somerset and Warren) said the country’s free enterprise system should lead doctors to come to the state if there are opportunities here, adding that the lack of new doctors is a symptom of the state’s failing economy and shows the need for reform of medical-malpractice laws.

Yesterday afternoon, Assembly Republican Policy Committee Co-chairwomen Assemblywoman Amy H. Handlin (R-Monmouth) and Assemblywoman Caroline Casagrande (R-Monmouth) met with doctors, medical residents, medical students and others at Jersey Shore University Medical Center in Neptune to discuss potential solutions to the looming shortage.

Jersey Shore President Steven G. Littleson noted that the Affordable Care Act is expected to expand insurance coverage to 25 million more Americans, who “will have insurance but will not have access to a physician if we do not do something about the gap” between the demand and the supply.

“At Jersey Shore we train over 100 residents – we’d love to expand that number but frankly we can’t afford to,” Littleson said.

Medical residents are largely funded by the federal Medicare program. The federal government has frozen the number of medical resident positions for existing programs. However, hospitals that do not have currently have residency programs will be eligible to receive federal funding to pay for new positions, but only after a five-year period during which the hospitals must pay for the positions.

Littleson said Jersey Shore parent Meridian is interested in opening a new residency program at Ocean Medical Center, but estimates the cost to be $2.5 million for six residents, a prohibitive sum.

This could be an area where the state could help offset the investment costs, perhaps through agencies like the New Jersey Economic Development Authority, several meeting participants including Briggs said.

“It ultimately is going to bring tremendous wealth, economic benefit to that community,” Briggs said of adding residency positions.

Handlin expressed disappointment that the state is subsidizing the training of doctors who plan to practice in other states.

Briggs suggested several solutions, including raising the Medicaid reimbursements in the state, which are among the lowest in the country, as well as bolstering the student loan redemption program and addressing the state’s medical-malpractice laws.

Meridian Senior Vice President Dr. Richard J. Scott said every state in the country is aware of growing shortages and will be competing to attract doctors to close the gap.

“It’s deep denial to say, ‘Let the rest of the country compete for those (doctors), let’s fill it with nurses,’ ” Scott said, referring to proposals to expand the number of advanced practice nurses (APNs).