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A Medical “Peace Corps�? Comes to New York State

Posted on | February 28, 2008 | No Comments

Is Gov. Spitzer’s program the solution for New York’s looming physician-supply crisis?New York state has been in a medical crisis and Albany is just becoming aware of the issues. Despite years of warnings about looming physician shortages coming from county and state medical societies, New York legislators turned a blind eye.  In their defense, constituents – patients and doctors – weren’t amassing large letter-writing campaigns heralding the doom and gloom spreading across New York.   Unlike proponents for rent control or advocates for school funding, desperately ill patients and their harried families don’t have time to write long letters lobbying for a more doctor-friendly, easy-access environment.  They’re too busy searching for doctors who can provide timely care and are overwhelmed with HMO red tape.  The doctors caring for these patients are too busy fighting HMO denials, toeing the line of government over-regulation to avoid jail-time, practicing defensive medicine to keep trial attorneys at bay, and trying to see as many patients each hour so as to keep their practices open.  In the case of heralding physician shortages, the silence is deafening.  

How is it that a state, which can brag about having twelve medical, two osteopathic schools and over 15,000 graduating residents each year, has a physician supply crisis?  Of all physicians trained in the U.S. (104,879 MDs), almost 15%  come from New York State.  Each year, over 50% of the doctors leave to practice elsewhere.  The Center for Health Workforce Studies at the University at Albany conducts an exit survey each year.  Their findings suggest that residents leave to be closer to family (26%) and because of non-competitive salaries (21%).  Currently, over 28% of New Yorkers live in designated “underserved” areas.  Select areas of the state have witnessed almost 20% reductions in OB/GYN and general surgical physicians.

So, lets’ analyze the data.  New York produces over 15,000 new physicians each year, and trains thousands of medical students but needs to correct a 25% incidence of physician undersupply largely across the entire upstate region.  What can Albany politicians do?  Fortunately, Governor Eliot Spitzer has begun to address the problem.  In the ‘State of the State Address’ on January 9, 2008, he proposed a program titled ‘Doctors Across New York’.  He stated, 

“There are huge regions of New York where doctors are scarce…From our inner cities to the North Country, our medically underserved New Yorkers deserve better…To attract doctors to these communities, we’re going to create a “Peace Corps” for doctors.”

Governor Spitzer is proposing to provide physicians and clinics grants and expanded reimbursement packages to encourage new primary care and specialist physicians to relocate practices to shortage areas (rural and inner-city).  The program looks to address loan repayment benefits and physician practice support benefits by working closely with the academic centers.   

It sounds great and appears to be a welcomed relief, but as usual, the details will determine how effective the program will be in retention of medical talent.  Graduating medical students have soaring loan debts with an average monthly repayment of almost $2000 for ten years.  While a healthy loan forgiveness program can lure graduates to underserved and undesirable locales, other factors can and will compete with these enticements.

Take, as an example, the tort system in New York State which is considered to be the bane of all practicing physicians.  Malpractice rates are seeing double digit increases and the New York State Trial Lawyers Association (NYSTLA) is running the most insulting ads accusing organized medicine of creating a ‘fear factor’ by promoting the public’s perception of reduced access to healthcare.  Be sure that New York doctors will pay more in malpractice costs to offset any savings in loan forgiveness…and run a greater risk of being sued!

Another concern is New York State taxes.  Without expounding on the burden that makes its residents one of the most highly taxed states, any loan savings will certainly be countered by increased state, county, town, school and sales tax payments.

Therefore, addressing the physician shortage certainly includes loan relief and incentive packages to practice in underserved areas but not at the expense of ignoring avaricious trial lawyers and liberal taxation philosophies.   All three areas must be addressed or physicians will continue to express their disinterest in New York, not by the sound of their voices, but by the sound of their feet.  Instead of the ‘Peace Corps’ coming to New York, it may be the National Guard Medical Corps that will be mobilized.

(Mark Lema, MD, is Professor and Chair of Anesthesiology at the University at Buffalo, Roswell Park Cancer Institute and past president of the American Society of Anesthesiologists. He can be reached at Mark.Lema@RoswellPark.org. Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)

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