The Maryland Hospital Association and MedChi, the state's medical society, conducted a study at the beginning of the year and concluded the state is wrestling with a drastic doctor shortage. And representatives from the medical community delivered this message to dozens of state lawmakers to urge them to make various changes to reverse the trend.
The state has 16 percent fewer physicians per capita than the national average, according to the organizations' research. Whereas the national average doctor-to-patient ratio is 212 physicians for 100,000 people, in Maryland there are approximately 178 doctors available to treat the same population size.
In Anne Arundel, as well as Baltimore, Baltimore City, Carroll, Harford and Howard counties, a handful of specialty fields are facing severe deficits in their number of doctors. MedChi claims the region lacks sufficient numbers of dermatologists, hematologists-oncologists, emergency medicine professionals, pathologists and thoracic surgeons.
Speakers at the forum in Severna Park Sept. 17 said the population is growing older - the number of elderly citizens is expected to double by 2030 - and will therefore need more medical care. That fact impacts the doctor shortage twofold, said Carmela Coyle, president and CEO of the hospital association.
"Physicians are baby boomers, too, and are aging just like the rest of the population," Ms. Coyle said.
Despite having top medical schools in the state, new doctors in Maryland often choose not to stay to practice medicine, speakers said, because major insurance carriers in the state have created a "hostile environment" for physicians.
MedChi's study concluded that, of the doctors who received their licenses through the state, only 52 percent go on to practice in Maryland.
"There is an HMO dominance in Maryland," said Jay Schwartz, a General Assembly lobbyist for MedChi. "They have the whip hand. A doctor negotiating against those managed-care facilities? It is a losing battle."
CareFirst BlueCross BlueShield is the most prevalent state health insurance carrier. Its top executives have a different perspective on the issue.
"While we believe there is no current broad-based physician shortage in Maryland, there are areas of the state - primarily rural communities - that have had long-standing, isolated access issues," CareFirst spokesman Michael P. Sullivan said in a prepared statement. "CareFirst is exploring ways to better link physician reimbursement with quality care. Our CareFirst Quality Rewards program and Medical Home pilot program will both launch in 2009 and are premised on the notion that if physicians are rewarded for providing high quality care, their patients will be healthier and care costs will be reduced in the long run."
The medical society, on the other hand, has called on state lawmakers to act on five issues:
Make insurance reimbursement rates to doctors competitive with other states' rates.
Reform the medical malpractice litigation system.
Increase Medicaid reimbursement rates in doctor-shortage areas.
Expand the state's loan-forgiveness program to attract doctors with student debt.
Support teaching programs to offer rotations in rural regions.
Del. Shane Pendergrass, D-Howard County, who was a panelist representing state legislators at the forum, is the vice chairman of the state's Health and Governmental Operations Committee. She spoke to the doctors' concerns with reimbursement rates.
"We're aware of the problems, and we're working toward solutions," Mrs. Pendergrass said.
The Health Care Access and Reimbursement Task Force was established in July 2007 for that purpose and will make recommendations, she said.
Dr. James York, Baltimore Washington Medical Center president, illustrated the problem with an anecdote. He said the take-home pay for a surgeon who performed an emergency appendectomy at his hospital was $300 for providing 90 days of that patient's care.
Dr. Ron Sroka, a Crofton primary-care doctor for 30 years and president-elect of MedChi, said a Government Accountability Office report ranked the Baltimore metro area 319th out of 319 in the rates paid out to doctors through private insurance reimbursements. That means doctors in the region get a far thinner slice of the profits here than in other areas of the country.
Dr. Sroka said Maryland doctors are not as wealthy as the public may think. With the low payout rates they receive from state insurance carriers, malpractice liability premiums, the cost of living and the amount of debt most physicians shoulder from medical school loans, practicing doctors here are strapped, he said.
But some health insurance companies disagree.
"We do not agree that increasing physician reimbursement rates is a solution to these isolated physician access issues," Mr. Sullivan said. "In fact, increasing reimbursements leads directly to higher health care costs for consumers."
Many Anne Arundel and Howard counties-based physicians voiced their concerns to the dozens of state lawmakers in attendance.
"There is a huge discrepancy from how doctors see this and how the businesses (which select insurance providers) and legislators see this," neurosurgeon Dr. Tom Ducker said to the elected officials. "I don't think they like us, and I don't think they understand us."
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