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There Are Ways To Address Physician Shortage

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By LOREN J. BARTELS

Published: November 16, 2007

Updated: 11/15/2007 06:33 pm

The Florida doctor shortage is more complex than The Tampa Tribune recently suggested (Our Opinion, Nov. 11). A major factor continues to be the unaffordable malpractice insurance expense and associated license risk.

As indicated, the Florida regulatory approach to malpractice continues to discourage young and mid-career out-of-state physicians from coming to Florida. In simple business terms, high malpractice risk and expense mean a less attractive lifestyle.

Other lifestyle issues are major, too. Specialties for which long on-call hours are common, such as trauma surgery, are difficult to attract physicians to. Primary care has become an enormous administrative burden. Not only is the lifestyle demanding for many front-line specialities, but the pay is too often low, in some cases so low as to make education loan repayment impossible.

Since many trauma victims and others who attend emergency rooms are uninsured, physician billing is often quite insufficient to cover the combination of business expense, medical school loans and the stress and strain.

While some hospitals pay fairly well for on-call services, many others pay at rates too low to attract specialists to cover emergency care. The result is that even attracting surgery trainees into trauma fellowship training has become extremely difficult. Likewise, starting primary care specialty practices is an enormous undertaking. Adding a partner to a small practice can be a daunting exercise in regulation, business planning, finance and organizational change.

The Tribune seemed to think that simply increasing training slots would go a long way toward solving the problem. While it is true the more training spots a state has the more likely it is graduated trainees will stay close by, it is also true that prospective trainees are savvy about what to expect in lifestyle, economics and medical practice stress.

If Florida and our nation wish to address the issues of specialty-specific physician shortages, stakeholders need to come together to reshape the landscape. Not just our more experienced physicians, but also our young doctors are still highly energized by the incredibly rewarding privilege of helping folks in trouble. Attracting altruistic, idealistic physicians to difficult specialties is hard to do not because of the work or the challenging personalities who need care, but because of co-factors that cause the effort to seem overly stressful, under appreciated even unreasonably risky.

More physician training slots in Florida would help in specialties for which recruiting is difficult, but it is at least as important to create new ways of providing care that match medical needs with venues and methods that are perceived as more acceptable. I strongly suspect that careful study will identify a number of ways to change so as to address society's physician shortages.

Loren J. Bartels is clinical professor of Otolaryngology at USF's College of Medicine and is a former chief of staff at Tampa General Hospital.

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