Physician shortage impacts Northwest OhioWritten by Kyle Reynolds | | email@example.com
Health care demand is plentiful in Lucas County, but the same can’t be said about the area’s physician work force.
Heart attack and cancer rates in Lucas County are above state and national averages, according to statistics compiled by Dr. Jeff Gold, dean of the UT College of Medicine, from information from the Ohio Department of Health.
But while Gold said Ohio is on par with the national average with approximately 250 physicians per 100,000 people, Northwest Ohio is experiencing a shortage with approximately 200 physicians per 100,000 people.
“We have inadequate physicians per capita, well under state and national averages,” Gold said.
Northwest Ohio has approximately 80 physicians per hospital compared to Ohio’s average of 170 per hospital and the U.S. average of 151 per hospital, according to statistics complied by Gold from information from the Ohio Department of Development, Ohio Hospital Association and Association of American Medical Colleges.
Toledo City Councilman Tom Waniewski, chair of health and community relations, said the problem is unique to the northwestern part of the state.
“Most physicians are setting up shop in the corridor that runs through Northeast Ohio with Cleveland, Akron and Canton and runs west to Cincinnati,” Waniewski said. “Ohio is doing okay nationally, but it is that other corridor (Northwest Ohio) that is seeing some deficiency.”
An aging work force
Many local physicians are over the age of 50, nearing retirement and having a hard time financially, which threatens to make the shortage worse, said Dr. Imran Andrabi, vice president and chief academic officer for St. Vincent Mercy Medical Center.
“Some of those physicians are not necessarily in the best financial situation given everything that is happening in the health care arena,” Andrabi said. “Physician reimbursements have gone down by 20 to 25 percent over the past 35 years. They are projected to go down even further.”
Another reason the aging workforce is a problem is because the new generation is not as willing to put in the same hours as older physicians would, said Andrabi.
“People don’t necessarily want to work the same hours that an older physician may have worked in the past and so it’s not a one-to-one,” Andrabi said. “So if you take out one physician working in the marketplace today and you fill that position with one physician, you can’t fill that one gap. It is our thought that you actually almost would need between two or 2.5 physicians to fill the gap for a practicing physician today in the marketplace.”
Lifestyle issues are of a greater concern to incoming physicians, said Andrabi.
“The focus of physicians in the past has been work, work, work, work,” Andrabi said. “The focus of the new generation is, ‘I like my work but I like to go golfing. I like my work but I want to go boating. I like my work but I want to spend time with my kids,’ and there is nothing wrong with that; it’s a shift in mindset.”
Retention of physicians
Andrabi said he wishes more UT students stayed in Toledo for their residencies, but that retaining physicians is the ultimate goal.
“I think the focus truly needs to be more on retaining the newly mentored physicians because they are the ones who will be able to practice and have something to do with the community; the students are still in training,” Andrabi said.
Andrabi said he doesn’t minimize the importance of keeping UT medical students in the region, but if they can recruit students into their residencies and have them practice here after graduation, that is what is important.
“What really makes a difference from a physician-manpower issue is how many of those residents are staying here,” Andrabi said. “Because if we could say, ‘well we retain 60 percent of the students to come into training programs and if more than half of them go away after their residency, we haven’t done our job.’ ”
At St. Vincent’s residency orientation, Andrabi stresses to residents that they aren’t just being recruited to train in Toledo but to practice in the community after graduation.
“The very first day I’ll tell them that they are not just coming to Mercy Health Partners or St. Vincent’s as a new resident, they are coming here because we want them to be here and we want to train them and keep them here in the community.”
On June 30, St. Vincent’s will graduate 62 residents, and most of them will remain in Northwest Ohio and Southeast Michigan, Andrabi said.
ProMedica Health System has two residency and two fellowship programs, including The Toledo Hospital Family Residency, The Toledo Hospital Sports Medicine Fellowship, The Flower Hospital Family Residency and the Toledo Hospital Vascular Surgery Fellowship.
Steve Mooney, president of ProMedica Health, Education and Research Corporation, said from 2000 to 2007, its family residency program has retained 56 percent of their residents in its service region of Northwest Ohio and Southeast Michigan.
The Flower Hospital Family Residency has retained 40 percent of its residents in the region since 2000, Mooney said.
ProMedica is invested in finding medical students with local connections and getting them involved in their programs as early as possible, Mooney said.
Mooney said he received an e-mail last year from a medical student who attends New York University and is a Southeast Michigan native. She was interested in the residency program but wouldn’t be done with medical school for a couple of years. Now she volunteers at the Toledo Hospital in the summer and comes along to some of the social events with the residents.
In a survey that was distributed to UT’s most recent graduating class of medical students, 2 percent of the participating students indicated UTMC as their first choice for a residency and 4 percent said they would choose another program in Toledo as their first choice.
Nine percent of those students said they planned on practicing post-residency in Toledo but 41 percent thought they would practice in Ohio.
Of the UT medical students graduating in 2007, 23 percent remained in Ohio for their residencies and 8 percent remained in Lucas County, according to Gold’s statistics.
One reason local medical students aren’t staying in Northwest Ohio is because many residencies in the area do not have their specialty, Gold said.
He said the local residency programs are “not nearly adequate in providing enough diverse fields.”
UTMC offers 15 residency programs in specialties such as family medicine, pediatrics, anesthesiology, radiology and urology but residencies in areas such as plastic surgery and ophthalmology are unavailable in Toledo.
Since some specialties aren’t represented at local residency programs, medical students have to leave the region for their residencies, which means to fill those specialty positions they have to relocate.
“Adding a residency in plastic surgery means there will be a pipeline of people to fill those positions in Northwest Ohio,” Gold said.
Rural areas to be hit hard
Lee Hammerling, chief medical officer of ProMedica Health System, is particularly concerned about the physician shortage in Northwestern Ohio’s rural areas.
Hammerling said Toledo is doing a good job of managing the shortage with the exception of shortages in certain specialties, but that rural areas are experiencing shortages in most specialties, primary care and family medicine.
It is hard to bring someone from another state or a metropolitan area to practice in a rural setting, said Hammerling, whose goal is to recruit physicians from the Toledo area who relocated elsewhere for a residency.
“The No. 1 reason a physician will settle in Northwest Ohio is geographic location,” Hammerling said. “We are more likely to recruit or retain people with ties to the region.”
Dr. Marcia Braun, a recent graduate of The Toledo Hospital Family Residency, will remain in ProMedica’s service region of Northwest Ohio and Southeast Michigan, along with three of the five other graduating residents in the program.
Braun, a native of Sandusky, will work at the Bellevue Hospital
“Primarily I chose to come here because of family,” Braun said.
Retaining UT medical students and people from Northwest Ohio means they are more likely to stay there than bringing in someone with no ties to the region, Hammerling said.
“In my heart of hearts I know it’s easier to keep them,” Hammerling said.
Confronting the shortage
As a way to confront the physician shortage in the region, the Ohio General Assembly created the Commission on the Future of Health Care Education and Physician Retention in Northwest Ohio, signed by Gov. Ted Strickland on June 30, 2007.
The commission is led by commission chair State Rep. Randy Gardner (R-Bowling Green) and commission vice-chair, State Rep. Peter Ujvagi (D-Toledo)
State Sen. Mark Wagoner (R- Toledo) and State Sen. Teresa Fedor (D-Toledo) are members of the commission, which also includes representatives from regional health care providers, health care professionals and Northwest Ohio business and labor organizations.
The commission has had a few meetings during the past year, and each member of the commission has submitted a list of recommendations to help curb the shortage, with a commission report on the recommendations expected soon, Wagoner said.
With so many medical students incurring high amounts of debt from school, Gold said he wants to see an incentive to keep them here after their graduation.
Gold said he wants debt forgiveness through tax abatement, loan abatement or scholarships for physicians who set up practice in Northwest Ohio.
Wagoner and Gold are working on legislation that would provide “one year of loan forgiveness for every year worked in Northwest Ohio as a physician provider.”
There would be additional incentives for physicians going into underserved specialties and native Ohioans, Gold said.
PHOTO: Dr. Jeff Gold is dean of the UT COllege of medicine. — Toledo Free Press photo by Lad Strayer