Health care facilities in Western New York and across upstate are facing a shortage of doctors, with hospital officials saying it’s particularly challenging to recruit primary care physicians, according to a new survey by a statewide hospitals association.
The physician shortfall has forced hospitals to reduce or eliminate certain services and to transfer patients to other facilities at times when they haven’t had the needed specialists in their emergency rooms, according to the survey by the Hospital Association of New York State, or HANYS.
The survey reports that 123 more doctors in this region retired, or moved, than began practicing here last year. Local hospitals also told HANYS that they have openings for 21 primary care physicians on their staffs. It is all part of a bleak health care picture painted for the Buffalo, Rochester and Syracuse areas.
“Primary care physicians are extremely difficult to recruit, particularly in upstate communities and rural communities,” said Sherry Chorost, director of workforce for the hospital association.
The HANYS 2013 Physician Advocacy Survey, based on responses from health care facilities across the state excluding New York City, found that hospitals and health systems statewide need more than 1,000 additional doctors – 26 percent of them primary care physicians.
The survey’s authors recommend boosting telemedicine initiatives – which would allow specialists to serve far-flung patients – and offering incentives to physicians who agree to pursue less lucrative specialities, such as primary care, or to practice in underserved areas of the state.
Since 2008, HANYS has issued an annual report based on a survey of its hospital and health system members, and the latest version raises the alarm on the declining number of doctors choosing to practice across New York and – specifically – a shortage of primary care physicians.
Western New York, where 4,618 physicians were licensed to practice as of January, lost 123 doctors during a 12-month period that ended in September, or about 3 percent of the ranks. That follows a loss of 184 doctors the previous year and 21 doctors the year before that, HANYS reported.
The region isn’t alone in bleeding doctors, according to the HANYS survey. The Syracuse area lost 163 doctors last year, for example, while the Rochester area lost 54, among the 1,026 lost statewide – not counting New York City – as fewer young doctors replace their retiring colleagues.
“The physicians here are aging. And there are more of them who are aging into retirement age than new people are coming in – that has been the problem,” said Dr. Nancy H. Nielsen, a senior associate dean at the University at Buffalo School of Medicine and Biomedical Sciences and a former president of the American Medical Association.
A decline in the physician population can leave hospital emergency rooms short-staffed for certain specialties, the survey found. That has happened at 61 percent of hospitals statewide – and 71 percent in the area north and west of the Hudson Valley.
It’s harder to attract doctors to the Buffalo area and the rest of upstate, particularly to rural communities, because young doctors want the amenities – and higher reimbursement rates – available in larger cities, experts say. Western New York’s reputation for brutal winter weather also doesn’t help.
“I think it’s hard because a lot of people don’t want to live in rural communities. It’s not the life that they’re looking for, necessarily. It’s a special person, I think, that wants to work in a rural community,” Chorost said.
Those recent medical school graduates who do decide to practice here generally are from the area or are married to a native, said Nielsen, who added that the new construction and new programs taking shape on the Buffalo Niagara Medical Campus are helping attract doctors here.
“There are challenges. I will say that, with the rejuvenation of the whole downtown area, we’re going to see very exciting things happening,” she said.
To address the physician shortfall, HANYS recommends expanding the Doctors Across New York, or DANY, program that, as one of its features, forgives up to $150,000 of student loan debt for young physicians who commit to practicing medicine in certain parts of the state for at least five years.
Medical school graduates from the class of 2012 left school with an average student loan debt of $166,750, according to the Association of American Medical Colleges. In the most recent round of the DANY program, 26 young doctors in 2013 received the full, five-year awards, Chorost said.
The HANYS survey also recommends greater use of telemedicine to allow certain specialists to remotely provide a consultation or other medical service to patients in underserved areas of the state.
And the survey highlighted the shrinking pool of primary care physicians as a particular area of concern.
Sixty-three percent of hospital officials surveyed said they don’t have enough primary care physicians, or other personnel, to meet their communities’ needs.
A key problem is the relatively low compensation for primary care doctors. Doctors who practice family medicine ranked 23rd out of the 25 specialties included in Medscape’s 2013 Physician Compensation Report.
They earned an average of $178,000 annually – healthy pay, when compared with that of the typical American, but well below the most profitable specialties of orthopedics, at $405,000, or cardiology, at $357,000.
“If you have a lot of debt you might be more inclined to go into a more lucrative specialty,” Chorost said.
Experts say there also is a lifestyle issue for primary care physicians, who must squeeze in more patients, work longer hours or remain on call for extended periods of time, particularly those who work in rural communities.
That comes on top of the administrative burden for physicians who run their own practices, said Dr. Thomas J. Madejski, a primary care physician in Medina who serves as assistant treasurer of the Medical Society of the State of New York.
“I think residents and medical students, as they go through school, they see how different physicians act and what their life is like, and that’s not an attractive part,” Madejski said.
To alleviate the primary care gap, the report recommends expanding the Primary Care Services Corps, which repays loans of nurse practitioners and physician assistants willing to work in underserved areas, and creating more Medicare-funded or state-funded residency slots for primary care doctors willing to work in upstate areas that need more physicians.